第2章 外陰癌 - 公益社団法人 日本婦人科 ...

1 38 2 1, 2 FIGO concurrent chemoradiotherapy ccrt CQ08 CQ10 vulvar intraepithelial neoplasia VIN VIN 52 100 human papillomavirus HPV 3 VIN VIN 1 VIN 3 3 2004 International Society for the Study of Vulvovaginal Disease ISSVD HPV VIN usual VIN uVIN HPV VIN differentiated VIN dVIN 4 2014 WHO 4 VIN HPV 2 HPV dVIN squamous intraepithelial lesion SIL SIL HPV SIL

2 SIL HPV low grade SIL LSIL high grade SIL HSIL LSIL HSIL HPV VIN 1 VIN 2, 3 5 27 HPV Bowen bowenoid papulosis uVIN HSIL 2 39 VIN CQ01 HPV HPV 6 radical vulvectomy 5 60 70 7 9 en bloc CQ02 QOL 10, 11 CQ03, CQ05 12 15 16 16 CQ05 17 CQ06 18 21 QOL 19 21 22 pelvic exenteration QOL 40 2 23 CQ04 QOL

3 24 CQ07 GOG37 2 25 26 CQ07 ccrt 27 29 CQ07 II IVA 4 II 27 64 31 70 27, 30 32 X 3 three dimensional conformal radiation therapy 3D CRT intensity modulated radiation therapy IMRT II 41 CQ08 CQ10 ccrt 1 1980 32 177 186 III 2 1995 47 685 693 III 3 Del Pino M, Rodriguez Carunchio L, Ordi J.

4 Pathways of vulvar intraepithelial neoplasia and squamous cell carcinoma. Histopathology 2013 62 161 175 III 4 Sideri M, Jones RW, Wilkinson EJ, Preti M, Heller DS, Scurry J, et al. Squamous vulvar intraepi-thelial neoplasia 2004 modified terminology, ISSVD Vulvar Oncology Subcommittee. J Reprod Med 2005 50 807 810 5 Crum CP, McCluggage WG, Herrington CS, et al. Epithelial tumours. Chapter 9 Tumours of the Vulva. World Health Organization Classification of Tumours of Female Reproductive Organs. Kurman RJ, Carcangiu ML, Herrington CS, Young RH, eds. IARC, Lyon, 2014 6 Kurman RJ, Toki T, Schiffman MH. Basaloid and warty carcinomas of the vulva. Distinctive types of squamous cell carcinoma frequently associated with human papillomaviruses. Am J Surg Pathol 1993 17 133 145 III 7 Taussig FJ. Cancer of the vulva an Analysis of 155 cases. Am J Obstet Gynecol 1940 40 764 779 III 8 Way S.

5 Carcinoma of the vulva. Am J Obstet Gynecol 1960 79 692 697 III 9 Iversen T, Aalders JG, Christensen A, Kolstad P. Squamous cell carcinoma of the vulva a review of 424 patients, 1956 1974. Gynecol Oncol 1980 9 271 279 III 10 Ghurani GB, Penalver MA. An update on vulvar cancer. Am J Obstet Gynecol 2001 185 294 299 IV 11 Saito T, Kato K. Management of lymph nodes in the treatment of vulvar cancer. Int J Clin Oncol 2007 12 187 191 IV 12 Homesley HD, Bundy BN, Sedlis A, Yordan E, Berek JS, Jahshan A, et al. Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva a Gyncologic Oncology Group Study . Gynecol Oncol 1993 49 279 283 III 13 Hopkins MP, Reid GC, Vettrano I, Morley GW. Squamous cell carcinoma of the vulva prognos-tic factors influencing survival. Gynecol Oncol 1991 43 113 117 III 14 Paladini D, Cross P, Lopes A, Monaghan JM. Prognostic significance of lymph node variables in squamous cell carcinoma of the vulva.

6 Cancer 1994 74 2491 2496 III 15 Andrews SJ, Williams BT, DePriest PD, Gallion HH, Hunter JE, Buckley SL, et al. Therapeutic implications of lymph nodal spread in lateral T1 and T2 squamous cell carcinoma of the vulva. Gynecol Oncol 1994 55 41 46 III 16 Ansink A, van der Velden J. Surgical interventions for early squamous cell carcinoma of the vulva. Cochrane Database Syst Rev 2000 2 CD002036 I 17 Levenback C, Burke TW, Morris M, Malpica A, Lucas KR, Gershenson DM. Potential applica-tions of intraoperative lymphatic mapping in vulvar cancer. Gynecol Oncol 1995 59 216 220 III 18 Hampl M, Hantschmann P, Michels W, Hillemanns P German Multicenter Study Group. Valida-tion of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer results of a multicenter study in Germany. Gynecol Oncol 2008 111 282 288 III 19 Van der Zee AG, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al.

7 Sentinel node dissection is safe in the treatment of early stage vulvar cancer. J Clin Oncol 2008 26 884 889 II 20 Zivanovic O, Khoury Collado F, Abu Rustum NR, Gemignani ML. Sentinel lymph node biopsy in the management of vulvar carcinoma, cervical cancer, and endometrial cancer. Oncologist 42 2 2009 14 695 705 III 21 Robison K, Holman LL, Moore RG. Update on sentinel lymph node evaluation in gynecologic ma-lignancies. Curr Opin Obstet Gynecol 2011 23 8 12 IV 22 Forner DM, Lampe B. Exenteration in the treatment of Stage III IV vulvar cancer. Gynecol Oncol 2012 124 87 91 III 23 van Doorn HC, Ansink A, Verhaar Langereis M, Stalpers L. Neoadjuvant chemoradiation for advanced primary vulvar cancer. Cochrane Database Syst Rev 2006 3 CD003752 III 24 H ckel M, Dornh fer N. Vulvovaginal reconstruction for neoplastic disease. Lancet Oncol 2008 9 559 568 IV 25 Homesley HD, Bundy BN, Sedlis A, Adcock L.

8 Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 1986 68 733 740 II 26 Faul CM, Mirmow D, Huang Q, Gerszten K, Day R, Jones MW. Adjuvant radiation for vulvar carcinoma improved local control. Int J Radiat Oncol Biol Phys 1997 38 381 389 III 27 Moore DH, Ali S, Koh WJ, Michael H, Barnes MN, McCourt CK, et al. A phase II trial of radia-tion therapy and weekly cisplatin chemotherapy for the treatment of locally advanced squa-mous cell carcinoma of the vulva a Gynecologic Oncology Group study. Gynecol Oncol 2012 124 529 533 III 28 Mak RH, Halasz LM, Tanaka CK, Ancukiewicz M, Schultz DJ, Russell AH, et al. Outcomes after radiation therapy with concurrent weekly platinum based chemotherapy or every 3 4 week 5 fluorouracil containing regimens for squamous cell carcinoma of the vulva. Gynecol Oncol 2011 120 101 107 III 29 Beriwal S, Shukla G, Shinde A, Heron DE, Kelley JL, Edwards RP, et al.

9 Preoperative intensity modulated radiation therapy and chemotherapy for locally advanced vulvar carcinoma analysis of pattern of relapse. Int J Radiat Oncol Biol Phys 2013 85 1269 1274 III 30 Landoni F, Maneo A, Zanetta G, Colombo A, Nava S, Placa F, et al. Concurrent preoperative chemotherapy with 5 fluorouracil and mitomycin C and radiotherapy FUMIR followed by limited surgery in locally advanced and recurrent vulvar carcinoma. Gynecol Oncol 1996 61 321 327 III 31 Montana GS, Thomas GM, Moore DH, Saxer A, Mangan CE, Lentz SS, et al. Preoperative chemo radiation for carcinoma of the vulva with N2 N3 nodes a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 2000 48 1007 1013 III 32 Moore DH, Thomas GM, Montana GS, Saxer A, Gallup DG, Olt G. Preoperative chemoradiation for advanced vulvar cancer a phase II study of the Gynecologic Oncology Group. Int J Radiat Oncol Biol Phys 1998 42 79 85 III CQ 01 43CQ 01 VIN L SIL A HSIL VIN dVIN wide local excision simple vulvectomy laser vaporization C1 1 VIN VIN WHO 2003 3 VIN 1 VIN 3 3 WHO 2014 4 38 VIN HPV LSIL HSIL HPV VIN dVIN 3 27 LSIL WHO VIN 1 HSIL VIN 2 VIN 3 LSIL HSIL VIN LSIL HSIL 6 1.

10 2 10 20 Bowen bowenoid papulosis HSIL 3 7 dVIN WHO simplex VIN VIN 1 VIN 3 33 LSIL HSIL 2, 8 LSIL HSIL dVIN WHO VIN 1 VIN 3 VIN 1 LSIL VIN 1 LSIL dVIN 44 2 9 LSIL HSIL dVIN VIN 3 9 3 10 11 VIN 2 VIN 3 HSIL 1, 12 HSIL HPV HSIL dVIN wide local excision simple vulvectomy dVIN QOL 13, 14 12 HSIL dVIN CO2 15 Bowen 3 30 4 5 FU LSIL HSIL 5.