***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To retrospectively investigate the outcome and toxicity of concurrent chemo-radiotherapy in the treatment of locally advanced vulvar cancer ( LAVC ) . Patients and Methods : Between 1996 and 2007 , 28 consecutive patients with LAVC were treated with  chemoradiation  ( 20 primary tumors and 8 loco-regional recurrences ) . Treatment consists of 2 separate courses of external-beam radiotherapy ( 40 Gy-2 weeks split-20 Gy ) . During each course of radiotherapy , 5-fluorouracil ( 1000 mg/m2/d ) , was given as a continuous intravenous infusion over the first 4 days , and mitomycin-C ( 10 mg/m2 on day 1 ) , as a bolus intravenous injection . Outcome measures were rates of complete and partial response , loco-regional control , progression-free survival , overall survival , and toxicity . Results : The median follow-up was 42 months and the median age of patients was 68 years . Twenty patients ( 72 % ) achieved complete remission , 4 patients ( 14 % ) partial remission , for an overall response rate of 86 % . Four patients ( 14 % ) had progressive disease directly after chemo-radiotherapy . The actuarial rates of loco-regional control , progression-free survival and overall survival at 4 years were 75 % , 71 % , and 65 % , respectively . There was no treatment break for acute toxicity . Vulvar desquamation was the main acute treatment-related side effect ( 93 % ) . Three patients developed transient grade 2 neutropenia or thrombocytopenia . Mild skin fibrosis and atrophy ( n = 6 , 21 % ) , radiation ulcer ( n = 4 , 14 % , in one patient treatment was needed ) , telangectasia ( n = 3 , 11 % ) , and lymphoedema ( n = 2 , 7 % ) were the most common late toxicity of chemoradiation . Conclusion : These data support the use of concurrent chemoradiotherapy as an effective alternative to primary ultra-radical surgery to treat LAVC with an acceptable toxicity profile Objective Vulvectomy for vulvar malignancy can affect sexual functioning based on anatomic , physiologic , psychologic , and relational mechanisms . The aims of this study were to prospect ively investigate sexual adjustment of women with vulvar malignancy during a follow-up period of 1 year after vulvectomy  and to compare the results with healthy control women . Methods In this prospect i ve controlled study , participants completed the  Beck Depression Inventory scale , World Health Organization-5 Well-being scale , Dyadic Adjustment Scale , Short Sexual Functioning Scale , and Specific Sexual Problems Question naire to assess various aspects of psychosocial and sexual functioning just before surgery , 6 months , and 1 year after treatment . Results Twenty-nine women with vulvar malignancy and 29 healthy controls completed the survey . Compared with the presurgery status , no significant differences were found in psychologic , relational , and sexual functioning in women after surgery for vulvar malignancy . Compared with healthy control women , women with vulvar malignancy reported significantly lower psychologic well-being and quality of partner relationship , both before and after treatment . Moreover , significantly more patients with vulvar malignancy reported preoperative and postoperatively sexual dysfunctions than healthy controls , including entry and deep dyspareunia , abdominal pain during intercourse , reduced ability to achieve orgasm , and reduced intensity of orgasm . Conclusions This prospect i ve study yielded no differences in psychosocial and sexual functioning for women with vulvar malignancy before and after vulvectomy . However , when compared with healthy controls , patients with vulvar malignancy are at high risk for sexual dysfunctions , both before and after surgical treatment PURPOSE To investigate the safety and clinical utility of the sentinel node procedure in early-stage vulvar cancer patients . PATIENTS AND METHODS A multicenter observational study on sentinel node detection using radioactive tracer and blue dye was performed in patients with T1/2 ( < 4 cm ) squamous cell cancer of the vulva . When the sentinel node was found to be negative at pathologic ultrastaging , inguinofemoral lymphadenectomy was omitted , and the patient was observed with follow-up for 2 years at intervals of every 2 months . Stopping rules were defined for the occurrence of groin recurrences . RESULTS From March 2000 until June 2006 , a sentinel node procedure was performed in 623 groins of 403 assessable patients . In 259 patients with unifocal vulvar disease and a negative sentinel node ( median follow-up time , 35 months ) , six groin recurrences were diagnosed ( 2.3 % ; 95 % CI , 0.6 % to 5 % ) , and 3-year survival rate was 97 % ( 95 % CI , 91 % to 99 % ) . Short-term morbidity was decreased in patients after sentinel node dissection only when compared with patients with a positive sentinel node who underwent inguinofemoral lymphadenectomy ( wound breakdown in groin : 11.7 % v 34.0 % , respectively ; P < .0001 ; and cellulitis : 4.5 % v 21.3 % , respectively ; P < .0001 ) . Long-term morbidity also was less frequently observed after removal of only the sentinel node compared with sentinel node removal and inguinofemoral lymphadenectomy ( recurrent erysipelas : 0.4 % v 16.2 % , respectively ; P < .0001 ; and lymphedema of the legs : 1.9 % v 25.2 % , respectively ; P < .0001 ) . CONCLUSION In early-stage vulvar cancer patients with a negative sentinel node , the groin recurrence rate is low , survival is excellent , and treatment-related morbidity is minimal . We suggest that sentinel node dissection , performed by a quality -controlled multidisciplinary team , should be part of the st and ard treatment in selected patients with early-stage vulvar cancer Abstract Objective To measure the long‐term impact of surgical treatment for vulval cancer upon health‐related quality of life and pelvic floor outcomes during the first year of therapy . Methods Prospect i ve , longitudinal , mixed‐ methods study . Twenty‐three women aged > 18 years with a new diagnosis of vulval cancer were recruited . The EORTC QLQ C30 , SF‐36 and an electronic pelvic floor assessment question naire ( ePAQ‐PF ) were administered at baseline ( pre‐treatment ) and 3 , 6 , 9 and 12 months post‐treatment . Mixed effects repeated measures models ( all adjusted for age and BMI ) were used to investigate changes over time and differences between cancer stage . Qualitative interviews were carried out with 11 of the women and analysed using a thematic approach . Results Mean age was 59.9 years ( SD = 15.3 ; range = 23.8–86.6 yrs ) . Mean BMI was 30.0 ( SD = 4.5 ; range = 24.4–38.2 ) . Sixteen women had early ( Stage 1 to 2B ) , and seven women had advanced stage disease ( Stage 3 to 4B ) . Question naire scores revealed that physical and social functioning , fatigue , pain and general sex life were significantly worse at 12 months than pre‐treatment ( p = < 0.05 ) . Qualitative analysis revealed multiple treatment side effects which were perceived as severe and enduring . Women with advanced vulval cancer had significantly worse SF‐36 mental health scores at 12 months compared to women with early stage disease ( p = 0.037 ) . Conclusions Surgery for vulval cancer has long‐term implication s which can be persistent 12 months post‐treatment . High rates of morbidity relating to lymphoedema and sexual function re‐enforce the need for specialist clinics to support women who suffer these complications . © 2015 The Authors . Psycho‐Oncology published by John Wiley & Sons OBJECTIVES To determine the efficacy and toxicity of radiation therapy and concurrent weekly cisplatin chemotherapy in achieving a complete clinical and pathologic response when used for the primary treatment of locally-advanced vulvar carcinoma . METHODS Patients with locally-advanced ( T3 or T4 tumors not amenable to surgical resection via radical vulvectomy ) , previously untreated squamous cell carcinoma of the vulva were treated with radiation ( 1.8 Gy daily × 32 fractions=57.6 Gy ) plus weekly cisplatin ( 40 mg/m(2 ) ) followed by surgical resection of residual tumor ( or biopsy to confirm complete clinical response ) . Management of the groin lymph nodes was st and ardized and was not a statistical endpoint . Primary endpoints were complete clinical and pathologic response rates of the primary vulvar tumor . RESULTS A planned interim analysis indicated sufficient activity to reopen the study to a second stage of accrual . Among 58 evaluable patients , there were 40 ( 69 % ) who completed study treatment . Reasons for prematurely discontinuing treatment included : patient refusal ( N=4 ) , toxicity ( N=9 ) , death ( N=2 ) , other ( N=3 ) . There were 37 patients with a complete clinical response ( 37/58 ; 64 % ) . Among these women there were 34 who underwent surgical biopsy and 29 ( 78 % ) who also had a complete pathological response . Common adverse effects included leukopenia , pain , radiation dermatitis , pain , or metabolic changes . CONCLUSIONS This combination of radiation therapy plus weekly cisplatin successfully yielded high complete clinical and pathologic response rates with acceptable toxicity Objective The aim of this study was to prospect ively monitor the patients ’ quality of life ( QoL ) after vulvar cancer surgery . Design The design was prospect i ve clinical study . Setting The study was set in the Department of Obstetrics and Gynecology , 2nd Medical Faculty of the Charles University and University Hospital Motol , Prague , Czech Republic . Methods A group of 36 patients underwent vulvar cancer surgery : 24 patients were subject to inguinofemoral lymphadenectomy ( RAD ) and 12 to sentinel lymph node biopsy .  To evaluate QoL , the European Organisation for Research and Treatment of Cancer , QoL question naires ( QLQ-C30 and QLQ-CX24 ) were administered to patients before and 6 and 12 months after surgery . Results In patients with vulvar cancer after inguinofemoral lymphadenectomy , increased fatigue and impaired lymphedema were observed . In the group of patients after sentinel lymph node biopsy , none of the QoL variables worsened postoperatively . Comparing both groups 12 months after surgery , the RAD group had significantly worse outcomes in body image and cognitive functioning than the sentinel lymph node biopsy group . Patients in the RAD group , who received adjuvant radiotherapy ( n = 13 ) , had worse QoL in symptom experience ( P < 0.05 ) at 6 and 12 months after the surgery than patients without radiotherapy ( n = 11 ) . Conclusions Less radical surgery showed objective ly better QoL results PURPOSE To determine the safety of sentinel lymph node biopsy as a replacement for inguinal femoral lymphadenectomy in selected women with vulvar cancer . PATIENTS AND METHODS Eligible women had squamous cell carcinoma , at least 1-mm invasion , and tumor size ≥ 2 cm and ≤ 6 cm . The primary tumor was limited to the vulva , and there were no groin lymph nodes that were clinical ly suggestive of cancer . All women underwent intraoperative lymphatic mapping , sentinel lymph node biopsy , and inguinal femoral lymphadenectomy . Histologic ultra staging of the sentinel lymph node was prescribed . RESULTS In all , 452 women underwent the planned procedures , and 418 had at least one sentinel lymph node identified . There were 132 node-positive women , including 11 ( 8.3 % ) with false-negative nodes . Twenty-three percent of the true-positive patients were detected by immunohistochemical analysis of the sentinel lymph node . The sensitivity was 91.7 % ( 90 % lower confidence bound , 86.7 % ) and the false-negative predictive value ( 1-negative predictive value ) was 3.7 % ( 90 % upper confidence bound , 6.1 % ) . In women with tumor less than 4 cm , the false-negative predictive value was 2.0 % ( 90 % upper confidence bound , 4.5 % ) . CONCLUSION Sentinel lymph node biopsy is a reasonable alternative to inguinal femoral lymphadenectomy in selected women with squamous cell carcinoma of the vulva BACKGROUND AND PURPOSE As late radiotherapy toxicity impacts negatively on the quality -of-life of cancer survivors and is often under reported , a study was set up to prospect ively collect patient-reported data in an unselected series of patients with gynaecological malignancy . Aim 1 - To provide 3 year results for the longitudinal study . Aim 2 - To improve the question naire used to collect data by identifying redundant items and modifying for use to collect Common Terminology Criteria for Adverse Events ( CTCAE ) data . MATERIAL AND METHODS Aim 1 - Patient reported outcome data were collected prospect ively by 226 patients before and up to 3 years following radiotherapy for gynaecological cancer using a question naire developed to collect 
    Output:
    
Conclusions Vulva cancer treatment is associated with considerable morbidity deteriorating QoL. To date , there is no vali date d PROM available that provides adequate coverage of VC-related issues .