Isolated local recurrence in carcinoma of the vulva: prognosis and implications for treatment

An isolated local recurrence in squamous cell carcinoma (SCC) of the vulva is reported to have a high surgical salvage rate. This study evaluates the impact of an isolated local recurrence on survival and evaluates predictive factors for outcome. Forty-seven patients were found to have an isolated local recurrence following definitive therapy for SCC of the vulva between 1980 and 1996 at a single institution. The primary and recurrent tumor's surgicopathological characteristics were retrospectively reviewed. Actuarial survival rates were calculated by the Kaplan Meier method and prognostic factors analyzed by the Cox proportional hazards model. Thirty-one patients were treated with surgery alone, 14 with combined therapy or radiation alone and two were not treated at recurrence. Actuarial 5-year survival was 40%. Treatment modality had no influence on outcome despite having bulkier recurrences in the combination or radiation group. On univariate analysis FIGO (International Federation of Gynecology and Obstetrics) stage at initial presentation, disease free interval of < one year, pathologically positive inguinal nodes at presentation, capillary lymphatic space involvement (CLS) at presentation and tumor size at recurrence were all significant predictors for survival. On multivariate analysis CLS in primary tumor, tumor size at recurrence, and pathologically positive nodes at initial presentation reached statistical significance. There was a high subsequent local and distant recurrence rate. An isolated first local recurrence does not have a uniformly good prognosis. Avoidance of local recurrence is important. With a high subsequent local and distant recurrence rate, more innovative treatment strategies are needed.