{"id":5603,"date":"2026-03-30T13:52:12","date_gmt":"2026-03-30T13:52:12","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/noortje-pleunis\/"},"modified":"2026-03-30T13:52:18","modified_gmt":"2026-03-30T13:52:18","slug":"noortje-pleunis","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/noortje-pleunis\/","title":{"rendered":"Noortje Pleunis"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":5606,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-5603","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"IMPROVING DIAGNOSIS AND TREATMENT OF PRIMARY AND RECURRENT VULVAR CANCER","samenvatting":"Er is geen Nederlandse samenvatting beschikbaar. De Engelse samenvatting vind je <a href=\"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/noortje-pleunis\/\">hier<\/a>.","summary":"This thesis is focused on exploring options for individualization of treatment in vulvar cancer patients. In chapter 1 we describe the incidence, pathogenesis, diagnosis and treatment of vulvar cancer based on current literature.\n\nDifferent topics have been studied to explore the possibilities for a more personalized approach now and in the next future. In order to achieve this goal, we aimed to:\n\n\u2022 analyse the incidence, organization of treatment, and survival of not only vulvar squamous cell carcinoma (SCC), but also less frequent histological subtypes (chapter 2)\n\u2022 evaluate the diagnostic process regarding the pre-operative work-up to rule out pulmonary metastases (chapter 3)\n\u2022 analyse the necessity of maintaining a 8mm resection margin in the surgical treatment of primary vulvar SCC, and to determine the impact of other prognostic factors (chapter 4)\n\u2022 study the complication rate and morbidity of surgical groin treatment, and identify patient groups at risk (chapter 5)\n\u2022 investigate the beneficial effect of adjuvant radiotherapy in patients with one intra-capsular lymph node metastasis (LNM) (chapter 6)\n\u2022 assess the incidence of LNM at first local recurrence and the impact of previous groin surgery (chapter 7)\n\nChapter 2\nThe incidence of vulvar SCC is rising, with a current incidence rate of 2.1 per 100.000 women. In this chapter we analyzed the trends in incidence, treatment and prognosis of other, less frequent histological subtypes such as basal cell carcinoma (BCC) and melanoma of the vulva. We performed a retrospective study of 6436 women with a vulvar malignancy, selected from the Dutch Cancer Registry. Additionally, patients with vulvar melanomas were matched to women with cutaneous melanomas on period of diagnosis, age, Breslow thickness, tumour ulceration, lymph node status and distant metastases. In total 489 women were diagnosed with a BCC and 350 with a melanoma of the vulva. Forty-five percent with BCC and 79% with melanoma were treated in a referral centre. There were no trends in age-adjusted incidence, but more patients with a BCC received surgical treatment over time. Having had a vulvar BCC did not affect life expectancy. Regarding melanomas of the vulva, the five-year relative survival increased from 37% in 1989\u20131999 to 45% in 2000\u20132012. Five years after diagnosis the survival of women with vulvar melanoma was 15% lower compared to matched cutaneous melanoma patients (p = 0.002). Well-known prognostic factors explained most of the differences in survival, however the difference of 15% remained unexplained.\n\nTumour spread in vulvar SCC can be either lymphatic or hematogenous. Whereas regional lymphatic spread to the groin is seen in 20\u201330% of patients, distant metastases are relatively rare. The scarce data on pulmonary metastases estimate a low incidence of 2\u20133%, nevertheless pre-operative work-up to rule out pulmonary metastases is advised in all patients. In this chapter we evaluated this approach through performance of a retrospective cohort study, in which we examined the incidence of pulmonary metastases in the preoperative work-up of 452 patients with primary vulvar SCC. Additionally, the frequency and consequences of coincidental findings was analyzed. In total, 80.8% of patients underwent pre-operative chest imaging (chest radiography or computed tomography (CT)) and seven patients (1.9%), with a median tumour size of 80 mm, presented with pulmonary metastases. None of the patients with early-stage disease who underwent a radical local excision (RLE) with sentinel lymph node (SLN) procedure, was diagnosed with pulmonary metastasis. Coincidental findings were reported in 40.7% of patients who underwent CT, compared with 15.8% of patients undergoing chest radiography, leading to clinically irrelevant diagnostic procedures. Therefore, we recommend omitting chest imaging in patients with early-stage disease and tumours <40 mm, considering chest CT only in patients with large tumours and\/or advanced stage disease.\n\nChapter 4\nSurgery is the cornerstone of treatment of vulvar SCC. National and international guidelines advise a surgical resection margin of 1-2cm at RLE, in order to maintain a 8mm histological margin. A minimal margin of 8mm is assumed to reduce the risk of local recurrence. Over the past years several studies however, have shown comparable incidence rates for narrower resection margins. In this chapter we retrospectively analyzed 167 patients with primary vulvar SCC undergoing surgical treatment. The median closest margin was 7.0 mm, and there was no significant difference in the risk of local recurrence for a resection margin <8 mm or \u22658 mm (25.0% and 22.2% respectively). The most important predictor of local recurrence was the presence of lichen sclerosus. A resection margin <8 mm in vulvar SCC can therefore be accepted, especially in tumours located close to clitoris, urethra or anus.\n\nChapter 5\nAdditional to local excision of the vulvar tumour, groin treatment is performed through a SLN procedure or inguinofemoral lymphadenectomy (IFL). Retrospective studies show that an IFL is indicated in approximately 50% of the patients because of the size of the tumour, multifocality, or positive sentinel lymph nodes. Postoperative complications are reported in 76% of patients, consisting of wound breakdown, infection, lymphocele, and lymphedema. In a retrospective study we analyzed the incidence of postoperative erysipelas and risk factors for its development. Of the 116 patients undergoing primary surgical treatment for FIGO stage IB-III vulvar SCC, 23 patients (20%) had 1 or more episodes of erysipelas. We found that the risk of developing erysipelas is three times higher in patients undergoing an IFL and in those with lymphedema, and it tends to be high in patients with diabetes.","auteur":"Noortje Pleunis","auteur_slug":"noortje-pleunis","publicatiedatum":"29 november 2024","taal":"NL","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/noortjepleunis?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202603301348","isbn":"978-94-6510-311-2","doi_nummer":"","naam_universiteit":"Radboud Universiteit","afbeeldingen":5607,"naam_student:":"","binnenwerk":"","universiteit":"Radboud Universiteit","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/5603","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=5603"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/5603\/revisions"}],"predecessor-version":[{"id":5604,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/5603\/revisions\/5604"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/5606"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=5603"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=5603"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}