Hide yo’ vulva.
The Study: If you don’t know who Michael Hockel is, it’s time meet him (you can watch his Steve Jobs-esque video here). He is the father of ontogenetic cancer field theory. He is a proponent of resecting embryologically-defined tissue fields. He is NOT a fan of radiation. Field theory is based on the idea that cancer is a form of reverse morphogenesis (an idea coined “catagenesis”) whereby cancer cells devolve and spread back along embryologically defined tissue layers. If you’re starting to think he’s crazy, Lancet Oncology disagrees. This month it published his report on vulvar field resections based on a staging system describing the involvement of specific ontogenetic fields. In it he argues wide local excision makes sense only within the confines of an embryologically defined field. While intriguing, this essentially translates into a vulvectomy--with a primary goal of avoiding the “horrors” of radiation. This single institution series of 97 patients demonstrates the feasibility and relative efficacy of the approach, though almost half experienced moderate to severe post-op complications.
Bottom Line: Ontogenetic cancer field theory is a provocative concept for locoregional cancer spread grounded in embryology, but it's a long way from ready for prime time.