What to do when nothing else is left to be done - metastatic non-HPV vulvar squamous cell carcinoma with multiple lines of chemotherapy
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http://orcid.org/0000-0001-9368-1922
Sandra Deac
http://orcid.org/0000-0001-6217-2025
Călin Cainap
http://orcid.org/0000-0002-7535-8766
Patriciu Achimaș-Cadariu
http://orcid.org/0000-0001-9928-5883
Mădălina Bota
http://orcid.org/0000-0001-7103-2120
Liliana Resiga
http://orcid.org/0000-0002-3498-834X
Dan Ștefan Luchian
http://orcid.org/0000-0001-9052-6505
Ovidiu Vasile Bochiș
http://orcid.org/0000-0001-9535-5848
Abstract
Recurrent vulvar squamous cell carcinoma with multiple site metastases is a rare entity – (up to 14.2% of the total number of recurrences), with a poor prognosis (only 15% of the patients alive at 5 years). Due to its “hard to find” character, there are no standardized guidelines available and the treatment is extrapolated from advanced cervical carcinoma, anal carcinoma and other squamous cell carcinomas. Immunotherapy has shown some positive results in vulvar carcinoma with PD-L1 positive, high TMB, high MSI or with MMR deficiency. An alternative for selected cases without therapeutic resources could be the HPV vaccine. We present the case of a 64-year-old woman diagnosed in 2014 with vulvar squamous cell carcinoma stage II for which she underwent radical vulvectomy with bilateral inguinal lymphadenectomy followed by external radiotherapy. In 2019 she developed local recurrence associated with lung, pleural, lymph nodes and subcutaneous metastasis, treated with three lines of chemotherapy: paclitaxel/carboplatin followed by cisplatin/5-fluorouracil and carboplatin/gemcitabine. The patients general health status altered progressively, and she died after the 4th cycle of carboplatin/gemcitabine. This cases management could be a starting point for the vulvar carcinoma cases where the standard therapeutical options do not represent a choice anymore, providing the necessary example on how to approach it.
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vulvar squamous cell carcinoma, recurrence, HPV, chemotherapy
2. Zobec Logar HB. Long term results of radiotherapy in vulvar cancer patients in Slovenia between 1997-2004. Radiol Oncol 2017; 51(4):447-454. https://doi.org/10.1515/raon-2017-0024
3. Peri M, Grassadonia A, Iezzi L, et al. A case of stage I vulvar squamous cell carcinoma with early relapse and rapid disease progression. Case Rep Oncol Med 2019; 2019:1018492. https://doi.org/10.1155/2019/1018492 .
4. Papatheodorou DC, Liakou CG, Kalogerakos K, Dimopoulos JKA, Kalinoglou N. Bilateral breast metastases from vulvar carcinoma: a case report and literature review. Case Rep Obstet Gynecol 2017; https://doi.org/10.1155/2017/1357203
5. Syed IMJ, Naveed A, Salman F, Faizan M, Mark S. The tell-tale heart: A case of recurrent vulvar carcinoma with cardiac metastasis and review of literature. Gynecol Oncol Rep 2017; (21):20-23. https://doi.org/10.1016/j.gore.2017.06.004
6. Woelber L, Jaeger A, Prieske K. New treatment standards for vulvar cancer 2020. Curr Opin Obstet Gynecol 2020; 32(1):9-14. https://doi.org/10.1097/GCO.0000000000000595
7. Rakislova N, Saco A, Sierra A, Del Pino M, Ordi J. Role of Human Papillomavirus in vulvar cancer. Adv Anat Pathol 2017; 24(4):201-214. https://doi.org/10.1097/PAP.0000000000000155
8. Deppe G, Mert I, Belotte J, Winer IS. Chemotherapy of vulvar cancer: a review. Wien Klin Wochenschr 2013; 125(5-6):119–128. https://doi.org/10.1007/s00508-013-0338-y
9. NCCN Guidelines Version 2 .2021. Vulvar Cancer (Squamous Cell Carcinoma). Information [https://www.nccn.org/professionals/physician_gls/pdf/vulvar.pdf avalable at 09/30/2021]
10. Gustafson LW, Gade M, Blaakær J. Vulvar cancer and HPV vaccination in recurrent disease. Clin Case Rep 2014; 2(6):243-246. https://doi.org/10.1002/ccr3.93
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