In re to conference this AM, there were some questions and confusion between the GOG 37 and 88 trials. Here are my notes on these two important trials -
Pelvic Nodal Control: GOG 37 (Homesley et al. OB Gyn 1986;68:733 PMID:3785783)
•Resectable vulvar SCC
•s/p radical vulvectomy & bil superficial and deep inguinal dissection found to have + inguinal LNs
•114 pts randomized to:
–Pelvic node dissection - PLND (15/53 patients had + pelvic LNs)
–RT (45-50 Gy to inguinal nodes and pelvic nodes BUT NOT vulvar region)
•50% of patients were cN0 (PE not sensitive for groin node mets)
•Groin recurrence PLND 13/55 vs RT 3/59 (p=0.02)
•OS (2) PLND 54% vs RT 68% (p=0.03)
Subgroup analysis showed benefit primarily to RT when >1 node was invovled, which has become standard for many gyn-oncs, however, this was a subgroup and should be interpreted with all of the standard caveats.
Inguinal Nodal Control: GOG 88(Stehman et al. IJROBP 1992;24:389)
•Resectable vulvar SCC; Excluded T1 lesions unless LVI or >5mm invasion; s/p radical vulvectomy
•58 pts randomized to
–Bilateral groin dissection, RT if positive
–Bilateral groin irradiation
•50 Gy/ 25fx, with 50% of dose given with 12-13 MeV electrons; Rx'd to 3 cm
•5/25 patients had + nodes in Arm A
OS and DFS were better in the dissected + selective RT arm, with a large portion of local failures in the RT arm in the groin.
However- the standard critique of this study is that RT was Rx'd to 3cm, which is clearly insufficient in many cases. See Koh IJROBP 1993;27:969-974 for a good discussion of this.
So there you go. GOG 37 is about pelvic nodes and GOG 88 is about inguinal.