Treatment patterns and outcomes in perineal primary vulvar cancer—a population‐based Swedish cohort study
6 affiliations
- 1Department of Obstetrics and Gynecology Sahlgrenska University Hospital Gothenburg Sweden
- 2Department of Oncology, and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- 3Regional Cancer Center Gothenburg Sweden
- 4Department of Gynecological Cancer Karolinska University Hospital Stockholm Sweden
- 5Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- 6Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
Abstract
Introduction: The choice of treatment for vulvar squamous cell carcinoma involving the perineum is challenging because of its anatomical proximity to the anus. The study aim was to describe treatment patterns, complications, and survival of women with perineal vulvar squamous cell carcinoma.
Material and Methods: A population‐based study at two tertiary referral hospitals during 2012–2020. Demographic and clinical data were retrieved from medical records. Survival and complications were analyzed according to treatment modality. Relative and progression‐free survival were calculated by Kaplan–Meier estimates.
Results: The cohort comprised 571 women with primary vulvar squamous cell carcinoma, of which 147 (26%) were located at the perineum. Seventy‐eight women (78/147; 53%) underwent surgery only with a median resection margin of 5 mm. In 34/147 women (23%), surgery was followed by adjuvant radiotherapy because of lymph node metastasis (74%) and/or insufficient margins (median resection margin 1.6 mm). Primary radiotherapy was delivered to 35/147 women (24%). Treatment‐related complications during the first year were recorded in 47% after surgery only, in 79% after adjuvant radiotherapy and in 71% after primary radiotherapy. After a median follow‐up of 41 months, disease progression occurred in 3% of women treated with surgery only, in 18% after adjuvant radiotherapy and in 33% after primary radiotherapy. The 2‐year progression‐free survival was 82% (95% CI, 74–91) after surgery only, 53% (95% CI, 38–73) after adjuvant radiotherapy, and 31% (95% CI, 19–51) after primary radiotherapy.
Conclusions: When diagnosed at an early‐stage, perineal vulvar squamous cell carcinoma can successfully be treated by primary surgery. The optimal treatment strategy for advanced disease remains uncertain and requires further investigation.
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BibTeX
@article{kjolhede2026treatment,
title = {{Treatment patterns and outcomes in perineal primary vulvar cancer—a population‐based Swedish cohort study}},
author = {Karin Kjölhede and Gabriel Lindahl and Christian Staf and Diana Zach and Katja Stenström Bohlin},
journal = {Acta Obstetricia et Gynecologica Scandinavica},
year = {2026},
month = jul,
doi = {10.1111/aogs.70315},
url = {https://doi.org/10.1111/aogs.70315},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Treatment patterns and outcomes in perineal primary vulvar cancer—a population‐based Swedish cohort study
AU - Karin Kjölhede
AU - Gabriel Lindahl
AU - Christian Staf
AU - Diana Zach
AU - Katja Stenström Bohlin
PY - 2026
DA - 2026/07/22
JO - Acta Obstetricia et Gynecologica Scandinavica
DO - 10.1111/aogs.70315
UR - https://doi.org/10.1111/aogs.70315
AB - Introduction: The choice of treatment for vulvar squamous cell carcinoma involving the perineum is challenging because of its anatomical proximity to the anus. The study aim was to describe treatment patterns, complications, and survival of women with perineal vulvar squamous cell carcinoma. Material and Methods: A population‐based study at two tertiary referral hospitals during 2012–2020. Demographic and clinical data were retrieved from medical records. Survival and complications were analyzed according to treatment modality. Relative and progression‐free survival were calculated by Kaplan–Meier estimates. Results: The cohort comprised 571 women with primary vulvar squamous cell carcinoma, of which 147 (26%) were located at the perineum. Seventy‐eight women (78/147; 53%) underwent surgery only with a median resection margin of 5 mm. In 34/147 women (23%), surgery was followed by adjuvant radiotherapy because of lymph node metastasis (74%) and/or insufficient margins (median resection margin 1.6 mm). Primary radiotherapy was delivered to 35/147 women (24%). Treatment‐related complications during the first year were recorded in 47% after surgery only, in 79% after adjuvant radiotherapy and in 71% after primary radiotherapy. After a median follow‐up of 41 months, disease progression occurred in 3% of women treated with surgery only, in 18% after adjuvant radiotherapy and in 33% after primary radiotherapy. The 2‐year progression‐free survival was 82% (95% CI, 74–91) after surgery only, 53% (95% CI, 38–73) after adjuvant radiotherapy, and 31% (95% CI, 19–51) after primary radiotherapy. Conclusions: When diagnosed at an early‐stage, perineal vulvar squamous cell carcinoma can successfully be treated by primary surgery. The optimal treatment strategy for advanced disease remains uncertain and requires further investigation.
SN - 0001-6349
SN - 1600-0412
ER -