“I think it’s really important that people keep signing up to these type of trials to push research forward.”
A study looking at testing sentinel lymph nodes, radiotherapy and chemotherapy for vulval cancer (GROINSS-VII)
This study is looking at whether it is safe to have radiotherapy instead of surgery when vulval cancer has spread to the sentinel lymph nodes.
The first treatment for vulval cancer is usually surgery. As well as removing the part of the vulva affected by cancer, the surgeon usually removes the
After surgery, women who have cancer cells in the lymph nodes may need to have additional treatment with radiotherapy. Sometimes you also have chemotherapy. Although combining surgery and radiotherapy may work well, it can cause side effects such as swelling in the legs (
In this study, researchers will find and test the lymph nodes nearest to the vulva. This is called sentinel node mapping.
If there are no cancer cells in the sentinel node, you will not have any more treatment.
If there is cancer in the sentinel nodes, but it is no more than 2mm in size, you will have radiotherapy. Some women taking part will also have chemotherapy. Doctors think that this will cause fewer side effects than the combination of surgery to remove all the lymph nodes followed by radiotherapy. But they need to find out if it is as good at stopping the cancer coming back.
A few women who are found to have cancer in the sentinel nodes which is bigger than 2mm in size, will have more surgery to remove all the lymph nodes.
The aims of the study are to
- Learn more about sentinel node mapping
- Find out if radiotherapy alone works as well as surgery (with or without radiotherapy) when the sentinel lymph nodes contain cancer cells
- Learn more about the short term and long term side effects of vulval cancer treatment
Who can enter
You can enter this trial if you
- Have been diagnosed with squamous cell carcinoma of the vulva
- Have a tumour that is smaller than 4cm across but has grown at least 1mm into the skin
You cannot enter this trial if
- Tests before your operation show that your cancer has definitely spread to the lymph nodes
- You have cancer in more than one area of the vulva
- Your cancer reaches your
urethra, vagina or anus (your doctor will explain whether or not this applies to you)
- You are pregnant or breast feeding
This is an international study and will recruit women in a number of different countries. Everybody taking part will have surgery to remove vulval cancer and the sentinel lymph nodes.
To find the sentinel nodes, the doctor will use some local anaesthetic cream to numb the skin around the cancer. They will then inject a small amount of a radioactive marker into the area around the cancer. The dose of radioactivity is very low. Following the injection a special type of camera takes a number of pictures to show which lymph nodes the marker goes to first. These are the sentinel nodes. You may have this test done on the day of your operation, or the day before.
During your surgery, the surgeon will inject a blue dye around the cancer. This also helps them to find the sentinel lymph nodes. The surgeon only removes the sentinel nodes and sends them to the laboratory to be checked for cancer cells. Your surgeon will not remove all the lymph nodes. In the laboratory, the sentinel nodes will be looked at very carefully. It can take about 2 weeks to get the results.
If no cancer cells are found in the sentinel lymph nodes, you won’t have any more treatment. You will have follow up appointments with the trial team for the next two years.
If there are cancer cells in the sentinel nodes, you may have radiotherapy. This will start within 6 weeks of your surgery. You usually have radiotherapy everyday (Monday to Friday) for 4 to 5 weeks. Some women may also have chemotherapy to make the cancer cells more sensitive to the radiotherapy. Doctors use a drug called cisplatin. You have it through a drip into a vein once a week during the 4 or 5 weeks of radiotherapy.
A few women may have more surgery to remove the
You will see the doctors and have some tests before you join the study. The tests may include
You are likely to be in hospital for between 1 and 4 days to have surgery.
The researchers expect to find positive sentinel lymph nodes in only 2 or 3 out of every 10 women tested. These women will need radiotherapy. If you do have radiotherapy, you will go to hospital every day for 4 or 5 weeks. Each treatment only takes a few minutes. If you have chemotherapy as well, one hospital visit each week will be longer.
Everybody taking part in the study will have follow up appointments with the trial doctors every 2 months for 2 years.
Your urine will be blue or green for a day after you have the blue dye. The dye may make your skin appear greyer than normal, but this will go off quickly.
Possible side effects of surgery to remove lymph nodes from your groin include
- Problems with the wound such as infection or breakdown
- Swelling of the groin
- Swelling of the legs (
Removing just the sentinel nodes causes fewer side effects than surgery to remove all the lymph nodes.
Side effects of radiotherapy to the lymph nodes can include
How to join a clinical trial
Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.
Professor Ate van der Zee
Cambridge University Hospitals NHS Foundation Trust
Dutch Cancer Society
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer
This is Cancer Research UK trial number CRUK/08/019.