Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins

Objectives: This study aims to evaluate whether re-excision or adjuvant radiation for stage I vulvar squamous cell carcinoma (SCC) with either a close or positive surgical margin improves recurrence-free survival. Methods: Patients with pathologically confirmed FIGO stage I vulvar SCC who underwent primary surgical management between January 1, 1995 and September 30, 2017 and had positive or close (<8 mm) surgical margins were included. Kaplan-Meier curves were generated and compared using the log-rank test. Results: Of 150 patients with stage I vulvar SCC, 47 (31.3%) had positive or close margins. Median follow-up time was 25 months (IQR 13–59 months). Twenty-one (44.6%) patients received additional treatment with re-excision (n = 17) or vulvar radiation (n = 4); 26 (55.3%) patients received no additional therapy. Patients with positive margins were more likely to receive additional therapy compared to patients with close margins (80% vs 35.1%, p = 0.03). The 2-year recurrence rates were similar between the no further therapy and the re-excision/vulvar radiation groups (11.5% vs 4.8%, p = 0.62). Local recurrence-free survival (RFS) and overall survival (OS) were similar between patients who received re-excision/vulvar radiation and patients who received no further therapy (p = 0.10 and p = 0.16, respectively). Subgroup analysis of the 37 patients with close margins demonstrated no difference in RFS or OS when patients received re-excision or adjuvant vulvar radiation compared to no additional therapy (p = 0.74 and p = 0.82, respectively). Conclusions: In our study, any additional treatment following primary surgical resection did not improve RFS or OS in stage IA and IB vulvar SCC. Larger studies are warranted in order to definitively determine the role of re-excision and adjuvant radiation in early stage disease.