子宫内膜癌的放射治疗

放射治疗(放疗)是子宫内膜癌的重要治疗方式。对于有高危因素的术后患者,辅助性放疗可明显改善肿瘤的局部控制率;对于不能手术的患者,根治性放疗是重要的替代治疗手段。放疗方式主要包括腔内照射和体外照射两种。     

子宫内膜癌的放射治疗

正子宫内膜癌(endometrial carcinoma)是发生于子宫内膜的上皮恶性肿瘤,多见于围绝经期和绝经后女性,是妇科常见的恶性肿瘤之一。早期(Ⅰ、Ⅱ期)子宫内膜癌治疗以手术为主,根据术后病理和(或)影像学检查是否存在高危因素行辅助放疗和(或)化疗等[1]。中晚期(Ⅲ～Ⅳ期)常采取手术+放射治疗±化疗的综合治疗方法。子宫内膜癌为放射治疗敏感肿瘤,无论是针对中晚期的根治性放疗还是早期的术前/术后辅助性放射治疗,对延长生存期、提高生活质     

子宫乳头状浆液性癌29例临床病理分析

目的 通过对子宫乳头状浆液性癌(UPSC)临床病理特征的分析,探讨合理的治疗方法.方法 回顾性研究1994年1月至2006年9月中国医学科学院肿瘤医院收治的29例UPSC.结果 29例中,3例单纯放疗,5例外院手术.全面手术分期21例,其中Ⅲ、Ⅳ期患者占81.0%(17/21).术前诊刮确诊率:47.6%,术后病理纯型占69.2%,混合型占26.9%,息肉型占3.8%,深肌层浸润占45.0%(9/21),腹膜后淋巴结转移率56.3%(9/16),大网膜转移率33.3%(4/12).92.3%(24/26)的患者术后接受化疗,34.6%(9/26)的患者术后接受化疗+放疗.Ⅲ期、Ⅳ<,B>期3年总存活率分别为64.8%、53.3%,5年总存活率分别为43.2%、0.单因素分析显示腹膜后淋巴结转移(P=0.014)、术中残存肿瘤(P=0.013)、辅助术后放疗(P=0.021)与预后有关,多因素分析显示仅术中残存肿瘤与预后有关(P=0.042).结论 子宫乳头状浆液性癌恶性程度高,预后差,诊断时晚期病例占大多数,强调手术应行全面的分期和最大限度的减瘤术,术后放疗可改善预后.     

晚期宫颈癌放疗配合动脉栓塞化疗的应用

目的:探讨动脉栓塞化疗对晚期宫颈癌的放射治疗效果.方法:选择124例宫颈癌患者,并随机分为放疗配合动脉栓塞化疗(综合组)62例和单纯放射治疗(单放组)62例.综合组:先进行常规的放射治疗,在第5天开始配合动脉栓塞化疗,采取经子宫动脉灌注,每次双侧子宫动脉共灌注化疗药顺铂40mg,表柔比星40 mg,丝裂霉素12mg、注入约30粒1 mm×1mm明胶海绵颗粒栓塞双侧子宫动脉,共2次.放疗外照采用6MV X射线照射.全盆腔照射DT:30Gy.内照采用Ir192后装机照射7次,A点DT:42 Gy,A点总量:72Gy.盆腔四野照射DT:16Gy.单放组:只进行常规的放射治疗.结果:综合组局部完全缓解率为80.7%,单放组局部完全缓解率为54.8%,两组比较差异有高度统计学意义(P＜0.01).结论:放疗辅以动脉栓塞化疗治疗效果较好,为晚期宫颈癌的有效治疗方法.     

乳腺癌改良根治术后时机不同放疗的疗效对比

目的:探讨乳腺癌改良根治术后时机不同放疗的疗效对比。方法:选择我院2009年4月到2010年3月130例乳腺癌改良根治术后放疗病人。分成治疗组(术后5周内接受放疗的79例患者)和对照组(术后13周接受放疗的51例患者)两组。两组放疗范围均为:同侧锁骨上野、同侧腋下及患侧胸壁。比较两组患者3年、5年胸壁复发率及远处转移率。结果:治疗组胸壁复发率为0.09%,对照组为19.6%%;治疗组远处转移率为13.9%,对照组远处转移率为25.5%,治疗组明显优于对照组且两组差异性显著,因而具有统计学意义(P<0.05)。结论:乳腺癌改良根治手术后患者,开始放射治疗时间越早,越有利于降低乳腺癌术后复发及转移率。     

子宫动脉介入化疗栓塞术联合放疗治疗子宫颈癌的远期疗效

目的 探讨子宫动脉介入化疗栓塞术联合放疗治疗宫颈癌的远期疗效.方法 回顾性分析兰州军区总医院自1999年1月1日至2009年8月31日间收治的经病理检查证实的632例Ⅱ～Ⅳa期宫颈癌患者的临床资料.其中,126例患者接受子宫动脉介入化疗栓塞术联合根治性放疗(动脉化疗+放疗组),506例患者仅接受根治性放疗(放疗组).晚期放射损伤按美国肿瘤放射治疗协作组和欧洲肿瘤治疗研究协作组(RTOG/EORTC)分级标准评价.对两组患者的预后及并发症的发生情况进行比较,并采用二项分类logistic回归法分析放疗并发症的相关危险因素.结果 (1)生存情况:所有患者总的1、2、5、8年生存率分别为94.4%、82.3%、48.8%、29.1%,其中动脉化疗+放疗组患者分别为96.0%、82.1%、37.2%、25.7%,放疗组分别为94.1%、80.8%、51.1%、31.5%,两组1、2年生存率分别比较,差异均无统计学意义(x2=0.009,P=0.993;x2=0.158,P=0.691),5、8年生存率分别比较,差异均有统计学意义(X2=11.197,P=0.001;x2=9.649,P=0.002).随访期内,动脉化疗+放疗、放疗组患者的复发转移率分别为77.0%(97/126)、73.3%(371/506),两组比较,差异无统计学意义(x2=0.705,P=0.401).(2)放疗并发症及其相关危险因素:所有患者Ⅱ级以上迟发性膀胱损伤发生率为5.5%(35/632),其中动脉化疗+放疗、放疗组分别为11.1%(14/126)、4.2%(21/506),两组比较,差异有统计学意义(x2=9.344,P=o.002).二项分类logistic回归法分析显示,子宫动脉介入化疗栓塞术是与迟发性膀胱损伤相关的危险因素(x2=6.440,OR=2.869,P=0.011).结论 子宫动脉介入化疗栓塞术联合放疗与单纯放疗比较,宫颈癌患者5、8年远期生存率明显降低,且子宫动脉介入化疗栓塞术为迟发性膀胱损伤发生的危险因素.因此,不推荐子宫动脉介入化疗栓塞术作为宫颈癌根治性放疗的常规辅助治疗措施.     

子宫内膜不典型增生术后病理升级为子宫内膜癌的危险因素分析

目的:研究子宫内膜不典型增生(AEH)术后病理升级为子宫内膜癌(EC)的相关危险因素。方法:选择2017年7月至2019年9月就诊于安徽医科大学第一附属医院门诊,经过诊断性刮宫明确为AEH并行全子宫切除术的166例患者为研究对象,并根据术后病理检查结果分为EC组(94例)和非EC组(72例)。分析患者术前与术后病理诊断的符合率、漏诊率及单因素和多因素Logistic回归分析AEH术后病理升级为EC的高危因素。结果:诊断性刮宫对AEH诊断的符合率为36.14%(60/166),对EC诊断的漏诊率为56.63%(94/166)。单因素分析结果示,EC组患者的发病年龄均值及年龄≥49.5岁、术前CA_(125)均值及CA_(125)升高、合并糖尿病的比例均显著高于非EC组患者,差异有统计学意义(P0.05)。多因素二分类Logistic回归分析示,发病年龄≥49.5岁(OR 4.548,95%CI 2.246～9.210,P=0.000)、CA_(125)升高(OR 7.635,95%CI 2.326～25.060,P=0.001)为AEH术后病理升级为EC的独立危险因素,而合并糖尿病(OR 2.969,95%CI 0.557～15.822,P=0.202)不是AEH升级为EC的独立危险因素。结论:临床上应对年龄大于49.5岁及CA_(125)升高的AEH高危人群加强筛查,以期对EC达到早期诊治的目的。     

Ⅰ～Ⅲ期子宫内膜癌淋巴结转移及预后的相关因素分析

目的:探讨国际妇产科联盟(FIGO)Ⅰ～Ⅲ期子宫内膜癌患者的临床病理特征与淋巴结转移及预后的相关因素。方法:选择2009～2020年于安徽医科大学第一附属医院妇科因子宫内膜癌行分期手术的患者1346例为研究对象(其中130例淋巴结阳性),对其临床病理特征行单因素及Logistic、Cox多因素回归模型分析与淋巴结转移及生存期预后的相关因素。结果:(1)单因素分析提示:病理类型、组织学分级、肌层浸润深度、肿瘤直径、子宫颈侵犯、淋巴脉管间隙浸润(LVSI)、术前CA_(125)及卵巢受累与淋巴结转移有关(P0.05)。多因素的Logistic回归分析显示:病理类型为非子宫内膜样癌、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/L、卵巢受累是淋巴结转移的独立危险因素(OR1,P0.05)。(2)单因素分析提示:病理类型、组织学分级、肌层浸润深度、子宫颈侵犯、LVSI、淋巴结转移、卵巢受累及术后辅助治疗与总生存期有关(P0.05)。多因素Cox回归验证及Kaplan-Meier生存曲线显示:非子宫内膜样癌、子宫颈侵犯、LVSI阳性和淋巴结转移是影响总生存期的独立危险因素(HR1,P0.05)。结论:特殊病理类型、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/ml及卵巢受累,对淋巴结转移风险具有独立预测意义。特殊病理类型、子宫颈侵犯、LVSI阳性及淋巴结转移是临床预后不良的有力预测因子。进一步完善子宫内膜癌分期手术和术后病理,为指导患者个体化治疗提供有效帮助。     

106例局部晚期宫颈癌根治性同步放化疗的临床疗效及预后影响因素

目的:分析无髂总淋巴结和腹主动脉旁淋巴结转移局部晚期宫颈癌患者根治性同步放化疗临床疗效、放疗毒性反应,探讨预后影响因素。方法:回顾分析2018年1月至2020年8月川北医学院附属医院肿瘤科放疗中心行根治性同步放化疗的106例局部晚期宫颈癌患者的临床资料,其中43例采用常规全盆腔放疗(PRT),63例采用盆腔延伸野放疗(EFRT)。通过实体瘤疗效评价标准评估近期疗效,用总生存期(OS)、无进展生存期(PFS)评估远期疗效。通过单因素和多因素分析影响预后的因素。依据肿瘤放射治疗协作组放射损伤分级标准评估放疗毒性反应。结果:106例患者客观缓解率为77.4%,疾病控制率为93.4%。1、3年OS率分别为95.2%、78.5%,1、3年PFS率分别为85.1%、68.1%。多因素分析显示,PRT是局部晚期宫颈癌患者OS(HR=3.78,95%CI为1.21～11.87,P=0.023)和PFS(HR=3.13,95%CI为1.302～8.428,P=0.012)的独立危险因素;盆腔淋巴结转移数目(<3枚和≥3枚)、近期疗效是影响OS的独立预后因素(P<0.05)。年龄、近期疗效是影...     

紫杉醇联合卡铂化疗并同步放疗治疗中晚期宫颈癌52例近期疗效观察

目的 对比观察紫杉醇联合卡铂同步放射治疗与单纯放射治疗的疗效及毒副反应.方法 将2001至2004年青海大学附属医院82例晚期宫颈癌患者,随机分为同步放化疗组52例和单纯放疗组30例.两组在同样放疗基础上,同步放化疗组给予TP方案(卡铂+紫杉醇)化疗,3-4周期.比较两组近期疗效和不良反应.结果 同步放化疗组近期有效率90.4%,单纯放疗组有效率63.3%,两组比较差异有统计学意义.同步放疗组平均生存期32.33个月,单纯放疗组平均生存期31.21个月,两组差异有统计学意义(P<0.05),两组近期不良反应发生率差异无统计学意义(P>0.05),不良反应经积极处理后能够耐受.结论 放疗同时联合TP方案化疗可显著提高晚期宫颈癌患者的近期疗效,不良反应并无明显增加.     

Prognostic factors of the uterine cervix adenocarcinoma

Background: Prognosis factors for adenocarcinoma of the uterine cervix after primary treatment are poorly established. Methods: A retrospective study of 45 cases of adenocarcinoma of the cervix with a follow-up of 96 months on average was performed. The primary treatment consisted in combined radical surgery and radiotherapy for stage I-II patients while patients with advanced disease were treated by radiotherapy. In case of poor prognosis factors, they were given chemotherapy. Survival rates were established and prognosis factors influencing survival and recurrences were studied. Results: Fifteen women remained alive without evolutive disease. FIGO stage and pelvic node involvement were the most important parameters influencing overall survival. Local failures (27%, average period of 30 months) were unpredictable and led to a dramatic outcome. Histological grade and pelvic node status were significant predictive factors for metastatic recurrence (40%, average period of 29 months). Conclusions: Local recurrence and metastatic dissemination of cervical adenocarcinoma after primary treatment prove to be rapidly fatal although life expectancy can be prolonged with adjuvant treatment of the recurrence. In the event of aggressive tumors with high histological grade and pelvic node involvement, an attempt to assess adjuvant systemic chemotherapy could be useful.     

The importance of adjuvant chemotherapy and pelvic radiotherapy in high-risk early stage endometrial carcinoma

Objective

To determine the impact of a policy change in which women with high-risk early stage endometrioid endometrial cancer (EEC) received adjuvant chemoradiotherapy.

Methods

This is a population-based retrospective cohort study of British Columbia Cancer Registry patients diagnosed from 2008 to 2012 with high-risk early stage EEC, who received adjuvant chemoradiotherapy after primary surgery. High-risk early stage was defined as the presence of two or more high-risk uterine factors: grade 3 tumor, more than 50% myometrial invasion, and/or cervical stromal involvement. Adjuvant therapy consisted of 3 or 4 cycles of carboplatin and paclitaxel chemotherapy, followed by pelvic radiotherapy. Sites and rate of recurrence were compared to a historical cohort diagnosed from 2005 to 2008 in which none of the patients received adjuvant chemoradiotherapy. Five-year progression-free and overall survival rates were calculated.

Results

The study includes 55 patients. All patients except for 2 received at least 3 cycles of chemotherapy. All patients received pelvic radiotherapy except for 2 who received brachytherapy only. Median follow-up was 27 months (7–56 months). Four patients (7.3%) recurred, including three with distant recurrence only and one with both a pelvic and paraaortic nodal recurrence. The historical cohort had a 29.4% recurrence rate, and therefore the hazard ratio for recurrence was 0.27 (95% CI 0.02–4.11). Five-year progression-free and overall survival rates were 88.6% and 97.3%, respectively.

Conclusion

Patients with high-risk early stage endometrial carcinoma treated with adjuvant chemoradiotherapy have a low rate of recurrence compared to those not receiving such therapy.     

Locoregional recurrence in patients with one to three positive axillary nodes after mastectomy without adjuvant radiotherapy.

PURPOSE: To retrospectively assess the risk of locoregional recurrence (LRR) and analyze the prognostic factors of this pattern of failure in patients with breast cancer and one to three positive axillary lymph nodes treated with modified radical mastectomy (MRM) without adjuvant radiotherapy. METHODS: From April 1991 through December 1997, 649 patients received a diagnosis of invasive breast cancer, and 545 were treated with MRM. Eighty-one of these patients who were found to have one to three positive axillary nodes and had a minimum follow-up of 2 years were included in this study. None of the 81 patients received adjuvant radiation therapy after mastectomy; 43 patients received adjuvant chemotherapy; and 60 patients received adjuvant hormone therapy. The median duration of follow-up was 39 months. RESULTS: Thirteen patients had LRR during follow-up, all within 2 years after mastectomy. The 3-year LRR rate was 14%. The 3-year rates of distant metastasis for patients with and without LRR were 48% and 14% (p = 0.03), respectively. The 3-year survival rates for patients with and without LRR were 73% and 87% (p = 0.01), respectively. In univariate analysis, age (p = 0.01), estrogen receptor (ER) status (p = 0.02), and the addition of hormone therapy (p < 0.001) were significant risk factors for LRR; in multivariate analysis, negative ER status (p = 0.02) was the only statistically significant risk factor. The 3-year LRR rates for ER-negative patients and those with positive or unknown ER status were 31% and 11%, respectively. CONCLUSIONS: LRR after mastectomy is a substantial clinical problem, despite the use of adjuvant chemotherapy and/or hormone therapy. Further randomized trials of postmastectomy radiotherapy for patients with one to three positive axillary nodes and specific risk factors are urgently needed to determine its potential benefit in locoregional control and survival, especially for young and ER-negative patients.     

An evidence-based approach to adjuvant therapy for stages I–II endometrial cancer

To review the literature in order to determine which patients with stages I–II of the endometrial adenocarcinoma (EC) require adjuvant therapy to achieve the best results with the least adverse effects.A medline literature search was done encompassing years 1980–2000 to locate references describing therapeutic approaches for patients with early stage EC. Factors reviewed include surgical pathologic criteria which would suggest increased risk of recurrence, outcomes from trials using adjuvant therapy, complications associated with use of adjuvant therapy and surveys on the patterns of care of use of adjuvant therapy.Thorough surgical staging has identified pathologic criteria which when present increase the risk of recurrence and have led to the use of post-operative therapy usually pelvic radiation therapy. Randomized trials with post-operative radiotherapy have shown improved local control, but none have shown a statistical improvement in survival. While radiation therapy after thorough surgical staging is associated with a greater complication risk than radiation after simple hysterectomy, thorough surgical staging has the benefit of being able to identify those patients at highest risk and thus spare those from the toxicity and expense of adjuvant therapy when the patient is in a low-risk group. Surveys of patterns of care suggest that in the absence of surgical staging more patients receive radiation therapy. There have been few reported trials on the use of adjuvant hormonal therapy or cytotoxic therapy and none have reported a survival benefit.Pelvic radiotherapy following surgery for EC improves local control but a survival benefit has not been shown. Thorough surgical staging with lymph node sampling best identifies those patients with an increased recurrence risk allowing the fewest patients to be subjected to the additional expense and potential toxicity of post-operative radiotherapy.     

Adjuvant radiotherapy in stage I-II epithelial ovarian cancer

OBJECTIVE: The purpose of this study was to assess the efficacy and side-effects of abdominopelvic irradiation applied as adjuvant postoperative therapy in early stage ovarian carcinomas. METHODS: From 1 January 1988 to 31 December 1993, 113 patients with FIGO stage IA-IIC epithelial ovarian carcinoma were treated with postoperative radiotherapy. Whole abdominal irradiation or lower abdominopelvic irradiation was used. The dose of specification was 20 Gy to the upper part of the abdominal cavity and 40 Gy to the lower part of the abdomen and the pelvic region. RESULTS: Primary cure was achieved in 110 patients (97%). During the period of follow-up, 33 cases of tumor recurrences (30%) were recorded. Abdominopelvic metastases were most frequent (18%). The overall 5-year survival rate for the complete series was 69% and the cancer-specific survival rate was 72%. Tumor grade was an independent and significant prognostic factor (Cox multivariate analysis; p = 0.007). Early radiation reactions of any type were noted in 93% of the cases and, in 11%, discontinuation of radiotherapy was necessary. Late radiation reactions were noted in 58% of the cases and the most common side-effect was diarrhea, but in most cases these reactions were of limited clinical significance. The incidence of severe bowel toxicity was 10% and, in two patients ( 1.8%), surgery was necessary due to late radiation reactions. CONCLUSIONS: Adjuvant abdominopelvic radiotherapy is one option among others (e.g. various types of chemotherapy or no further treatment) in primary treatment of early stage ovarian carcinoma. The optimal adjuvant therapy for this group of patients is not known today and further prospective and randomized studies are needed.     

Prognostic factors in FIGO stage IB cervical cancer without lymph node metastasis and the role of adjuvant radiotherapy after radical hysterectomy

OBJECTIVES: The aim of this study was to evaluate the clinical and pathologic prognostic variables for disease free survival, overall survival and the role of adjuvant radiotherapy in FIGO stage IB cervical carcinoma without lymph node metastasis. METHODS: A retrospective review was performed of 393 patients with lymph node negative stage IB cervical cancer treated by type 3 hysterectomy and pelvic lymphadenectomy at the Hacettepe University Hospitals between 1980 and 1997. RESULTS: The disease free survival and overall survival were 87.6 and 91.0%, respectively. In univariate analysis, tumor size, depth of invasion, vaginal involvement, lympho-vascular space involvement (LVSI) and adjuvant radiotherapy were found significant in disease free survival. Overall survival was affected by tumor size, LVSI, vaginal involvement and adjuvant radiotherapy. Tumor size, LVSI and vaginal involvement were found as independent prognostic factors for overall and disease free survival in multivariate analysis. Disease free survival, recurrence rate and site did not differ between patients underwent radical surgery and radical surgery plus radiotherapy. CONCLUSION: Tumor size, LVSI and vaginal involvement were independent prognostic factors in lymph node negative FIGO stage IB cervical cancer. Adjuvant radiotherapy in stage IB cervical cancer patients with negative nodes provides no survival advantage or better local tumoral control.     

Clinical and pathologic correlates in surgical stage II endometrial carcinoma

OBJECTIVE: To identify the surgical, pathologic, and therapeutic factors that influence outcome in patients with surgical stage II endometrial adenocarcinoma. METHODS: All patients with comprehensively staged stage II endometrial adenocarcinoma were identified. Data regarding preoperative, surgical, pathologic, adjuvant therapy, and outcomes were collected. Factors were compared with the chi(2) test, and survival curves were generated and compared with the log rank test. RESULTS: Of 162 patients with surgical stage II endometrial cancer, the median age was 65 years, and the median body mass index was 31.2 kg/m(2). An extrafascial hysterectomy was performed in 75% of cases, whereas 25% of patients underwent radical hysterectomy. At least 10 nodes were recovered in more than 90% of cases. Stage IIA disease was present in 52% of cases, whereas stage IIB accounted for the remaining 48%. After staging, 48% of patients had adjuvant radiation therapy (16% with brachytherapy alone). The remainder received no adjuvant therapy. At a median follow-up of 26 months, 17% experienced disease recurrence. Five-year overall survival rate was 88% and disease-free survival rate was 81%. A significantly better 5-year disease-free survival rate was seen in patients undergoing radical hysterectomy compared with extrafascial hysterectomy (94% compared with 76%, P=.05). Adjuvant radiation did not lead to improved survival. CONCLUSION: In this large series of surgical stage II endometrial cancer cases, improved survival was noted relative to historical controls and in particular with radical compared with extrafascial hysterectomy.     

Radiotherapy is not indicated in patients with vulvar squamous cell carcinoma and only one occult intracapsular groin node metastasis

ObjectiveMost guidelines advise no adjuvant radiotherapy in vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis. However, several recent studies have questioned the validity of this recommendation. The aim of this study was to analyze the groin recurrence rate in patients with a single intracapsular positive lymph node treated without adjuvant radiotherapy.MethodsPatients with a single clinically occult intracapsular lymph node metastasis, treated without adjuvant radiotherapy, formed the basis for this study. Groin recurrences, and the risk of death, were analyzed in relation to the size of the metastasis in the lymph node and the lymph node ratio. Data were analyzed using SPSS, version 26.0 for Windows.ResultsAfter a median follow-up of 64 months, one of 96 patients (1%) was diagnosed with an isolated groin recurrence and another two (2.1%) were diagnosed with a combination of a local and a groin recurrence. The only isolated groin recurrence occurred in a contralateral lymph node negative groin. Size of the metastasis and lymph node ratio had no impact on the groin recurrence risk, nor on survival. The 5-year actuarial disease-specific and overall survivals were 79% and 62.5% respectively. The 5-year actuarial groin recurrence-free survival was 97%.ConclusionBecause of the low risk of groin recurrence and the excellent groin recurrence-free survival, we recommend that adjuvant radiotherapy to the groin in patients with vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis can be safely omitted to prevent unnecessary toxicity and morbidity.     

Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis

OBJECTIVES: To determine the importance of margin status and other prognostic factors associated with the recurrence and survival of patients with squamous cell vulvar carcinoma. METHODS: Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression. All slides were re-reviewed by two gynecologic pathologists. RESULTS: Ninety patients (median age: 69) were treated for vulvar carcinoma from 1984 to 2002, including 28 FIGO stage I, 20 stage II, 26 stage III and 16 with stage IV disease. Sixty-three (70%) patients underwent complete radical vulvectomies and 27 (30%) had modified radical vulvectomies. Nineteen (20%) patients received adjuvant radiotherapy. Five-year disease-specific survival rates were 100%, 100%, 86% and 29% for stages I-IV, respectively. None of the 30 patients with a pathologic margin distance >8 mm had local recurrence. Of the 53 women with tumor-free pathologic margin of <8 mm, 12 (23%) had a local recurrence. Moreover, women with >2 positive groin nodes had significantly higher recurrence risk compared to those with <2 metastatic groin nodes (p<0.001). On multivariate analysis, positive groin nodes and margin distance were important prognostic factors for recurrence. Moreover, stage, tumor size, margin distance, and depth of invasion were significant independent predictors for disease-specific survival. The median follow-up was 58 months (range: 2-188). CONCLUSIONS: Pathologic margin distance is an important predictor of local vulvar recurrence. Our data suggest that a > or =8-mm pathologic margin clearance leads to a high rate of loco-regional control.