Page 9 - ESGO - Vulvar cancer - Complete report_fxd2

5.5 Sentinel lymph node procedure

c

B The sentinel lymph node procedure is recommended in patients with unifocal cancers of < 4 cm,
without suspicious groin nodes.

B Use of radioactive tracer is mandatory, use of blue dye is optional.

C Lymphoscintigram is advised to enable the preoperative identification, location and number of sentinel
lymph nodes.

C Intraoperative evaluation and/or frozen sectioning of the sentinel lymph node can be performed in an
attempt to prevent a second surgical procedure. Caution is warranted because of an increased risk of
missing micrometastases on final pathology due to the loss of tissue arising from processing for frozen
section assessment.

 When a sentinel lymph node is not found method failure, inguinofemoral lymphadenectomy should
be performed.

c

C Where metastatic disease is identified in the sentinel lymph node any size: inguinofemoral
lymphadenectomy in the groin with the metastatic sentinel lymph node.

 For tumours involving the midline: bilateral sentinel lymph node detection is mandatory. Where only
unilateral sentinel lymph node detection is achieved, an inguinofemoral lymphadenectomy in the
contralateral groin should be performed.

c

C Pathological evaluation of sentinel lymph nodes should include serial sectioning at levels of at least
every 200 µm. If the H&E sections are negative, immunohistochemistry should be performed.

5.6 Radiation therapy

 Adjuvant radiotherapy should start as soon as possible, preferably within 6 weeks of surgical treatment.
 When invasive disease extends to the pathological excision margins of the primary tumour, and further

surgical excision is not possible, postoperative radiotherapy should be performed.
 In case of close but clear pathological margins, postoperative vulvar radiotherapy may be considered to

reduce the frequency of local recurrences. There is no consensus for the threshold of pathological
margin distance below which adjuvant radiotherapy should be advised.

B Postoperative radiotherapy to the groin is recommended for cases with > 1 metastatic lymph node
and/or presence of extracapsular lymph node involvement.

 Adjuvant radiotherapy for metastatic groin nodes should include the ipsilateral groin area and where
pelvic nodes are non-suspicious on imaging, the distal part of the iliac nodes with an upper limit at the
level of the bifurcation of the common iliac artery.

C Based on evidence from other squamous cell cancers such as cervical, head & neck, and anal cancer,
the addition of concomitant, radiosensitising chemotherapy to adjuvant radiotherapy should be
considered.

 VULVAR CANCER - GUIDELINES 
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