{"id":2297,"date":"2026-06-11T11:00:00","date_gmt":"2026-06-11T14:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2297"},"modified":"2026-06-11T11:00:00","modified_gmt":"2026-06-11T14:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-vulvar-vulvectomia-radical-ifl-brachy-pembrolizumab-gog-240","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-vulvar-vulvectomia-radical-ifl-brachy-pembrolizumab-gog-240\/","title":{"rendered":"PGRSS vulvar: vulvectomia, IFL, brachy, pembro"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica vulvar que reduzem PGRSS a descarte de esp\u00e9culo e gaze<\/strong>. Em 2026, h\u00e1 um cen\u00e1rio desafiador \u2014 cl\u00ednicas de cir oncol\u00f3gica vulvar<\/strong> + CV carcinoma vulva escamoso 80%+adenoCa Bartholin+melanoma vulvar+sarcoma+Paget extramam\u00e1rio<\/strong> + HPV-driven 30-40% jovem+HPV-independent 60-70% diferenciado VIN+lichen escleroso atr\u00f3fico<\/strong> + vulvectomia radical Way+parcial+modified+skinning+laser CO2 VIN<\/strong> + IFL Inguinal-Femoral Lymphadenectomy bilateral+Cloquet+SLN sentinela GROINSS-V Tc-99m+ICG<\/strong> + brachy intersticial Iridium-192 vulva<\/strong> + pembrolizumab GOG 240+KEYNOTE-826 + cemiplimab Libtayo escamoso recurrent + tisotumab vedotin+nivolumab+ipilimumab<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (CV escamoso+adenoCa Bartholin+melanoma+sarcoma+Paget+VIN vulvar intraepithelial neoplasia high-grade+HSIL) + Grupo A4 (IFL inguinal+femoral superficial+profunda+il\u00edaca interna externa+SLN GROINSS-V) + Grupo C (Iridium-192 brachy intersticial+CTV-HSIL EMBRACE-II) + Grupo E (perfuro bi\u00f3psia incisional+excisional+colposcopia vulvar+laser CO2+LEEP) + Lista C5 (cisplatina+5-FU concomitante RT GOG 205 + cisplatina+paclitaxel+bevacizumab GOG 240 + pembrolizumab Keytruda Merck KEYNOTE-826\/A18+nivolumab Opdivo BMS CheckMate-358+ipilimumab Yervoy+tisotumab vedotin Tivdak InnovativeBio Pfizer ADC tissue factor+cemiplimab Libtayo Regeneron PD-1 EMPOWER+nadofaragene firadenovec+atezolizumab Tecentriq+balstilimab Agenus+dostarlimab Jemperli RUBY-1 raro Lista C5).<\/p>\n

Para o gestor que opera ou planeja cl\u00ednica de cir oncol\u00f3gica vulvar, \u00e9 fundamental dimensionar PGRSS espec\u00edfico desde o in\u00edcio.<\/p>\n

Os 5 fluxos oncol\u00f3gicos vulvares<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS vulvar tem 5 fluxos.<\/p>\n\n\n\n\n\n\n\n\n\n
Fluxo<\/th>\nVolume<\/th>\nFrequ\u00eancia<\/th>\nParticularidade<\/th>\n<\/tr>\n<\/thead>\n
A1 CV escamoso+VIN<\/td>\n5-13 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nHPV+\/HPV-+CID C51<\/td>\n<\/tr>\n
A4 IFL+SLN GROINSS-V<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nSentinela ICG+Tc-99m<\/td>\n<\/tr>\n
C brachy Iridium-192<\/td>\n0,5-1,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nCTV-HSIL+CNEN<\/td>\n<\/tr>\n
E LEEP+laser CO2<\/td>\n0,4-1,2 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nColposcopia vulvar<\/td>\n<\/tr>\n
Lista C5 GOG+pembro<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nKEYNOTE-826+EV-103<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 11,4-32,2 kg\/dia<\/strong> em cl\u00ednica cir oncol\u00f3gica vulvar m\u00e9dia porte.<\/p>\n

A1 CV escamoso + VIN + HPV-driven vs HPV-independent: o est\u00e1gio cir\u00fargico+screening<\/h2>\n

A primeira camada do PGRSS vulvar \u00e9 A1. Padr\u00e3o setorial inclui (a) CV carcinoma vulva escamoso 80%<\/strong> com HPV-driven 30-40% jovem + HPV-independent 60-70% p\u00f3s-menopausa+lichen escleroso atr\u00f3fico+lichen plano+VIN diferenciado dVIN; (b) VIN vulvar intraepithelial neoplasia<\/strong> com HSIL high-grade squamous+dVIN+VLBP-VIN+VAAD+ISVD reclassifica\u00e7\u00e3o ISSVD 2015 + HPV testing universal; (c) outros tumores vulva<\/strong> com adenoCa Bartholin gl\u00e2ndula 5% + melanoma vulvar 5-10% + sarcoma raro + Paget extramam\u00e1rio + sarcoma+lipossarcoma rar\u00edssimo + VIN diferenciado; (d) estadiamento FIGO 2021 ISGYP<\/strong> Stage I-IV + IA<2cm <1mm invas\u00e3o + IB>2cm + II infiltra\u00e7\u00e3o 2\/3 inferior uretra\/vagina\/anal + III ipsilateral inguino-femoral LN + IV p\u00e9lvica\/dist\u00e2ncia + CID C51; (e) Pap+colposcopia vulvar+screening<\/strong> com colposcopia \u00e1cido ac\u00e9tico + lugol Schiller + bi\u00f3psia 4mm punch+excisional + ISSVD International Society Study Vulvovaginal Disease + ASCCP 2019 management.<\/p>\n

Cl\u00ednica com A1 vulvar madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza FIGO 2021+ISSVD+ASCCP<\/strong>. Como discutimos no post sobre vulvovaginal<\/a>, A1 vulvar \u00e9 base.<\/p>\n

A4 vulvectomia radical Way + IFL + SLN GROINSS-V + reconstru\u00e7\u00e3o: o est\u00e1gio cir\u00fargico<\/h2>\n

A segunda camada \u00e9 t\u00e9cnica. Padr\u00e3o setorial inclui (a) vulvectomia radical Way<\/strong> com remo\u00e7\u00e3o completa vulva + 2cm margem grossa + ressec\u00e7\u00e3o pele+subcut\u00e2neo+f\u00e1scia perfundida; (b) vulvectomia parcial+modified<\/strong> com hemivulvectomia + skinning vulvectomia VIN + simples + indica\u00e7\u00e3o tumor focal+VIN; (c) IFL Inguinal-Femoral Lymphadenectomy<\/strong> com superficial + profunda femoral + Cloquet + ipsilateral lateral T1+IB + bilateral central+>4cm + linfedema membro inferior 30-60% complica\u00e7\u00e3o; (d) SLN sentinela GROINSS-V trial<\/strong> com Tc-99m + ICG indocyanine green + DSL Dynamic Sentinel Lymph Node + isolamento + ultrastaging IHC + GROINSS-V 1+2 + omitir IFL completa SLN-negativo unifocal <4cm; (e) reconstru\u00e7\u00e3o pl\u00e1stica<\/strong> com flap V-Y advancement + Limberg rhomboid + pudendal thigh + gracilis myocutaneous + VRAM rectus abdominis + perineal closure.<\/p>\n

Cl\u00ednica com A4 vulvectomia+IFL+SLN+reconstru\u00e7\u00e3o madura escala R0 90+%<\/strong> + escala SLN GROINSS-V omite IFL 30%<\/strong> + previne linfedema 30-60% IFL completa<\/strong>. Conex\u00e3o com vulvovaginal IFL<\/a>.<\/p>\n

Brachy Iridium-192 + cisplatina+RT + pembrolizumab GOG 240 + Tivdak ADC: o est\u00e1gio radio+sist\u00eamico+ADC<\/h2>\n

A terceira camada \u00e9 brachy+sist\u00eamico+targeted. Padr\u00e3o setorial inclui (a) brachy intersticial Iridium-192 vulva<\/strong> com agulhas paralelas + Syed-Neblett template + Martinez Universal + LDR low dose rate + HDR high dose rate + after-loading remote + dosimetria 3D ICRU-58\/89 + CTV-HSIL EMBRACE-II; (b) RT EBRT preop+definitivo<\/strong> com 50,4 Gy\/28 fra\u00e7\u00f5es + cisplatina concomitante 40 mg\/m\u00b2 weekly GOG 205 + IMRT intensity-modulated + IGRT image-guided + boost 14-19 Gy intersticial; (c) GOG 240 pembrolizumab+chemo<\/strong> com pembrolizumab Keytruda Merck PD-1 + cisplatina+paclitaxel + bevacizumab Avastin Genentech VEGF + KEYNOTE-826 1L PD-L1 CPS\u22651; (d) cemiplimab Libtayo Regeneron PD-1 escamoso recurrent EMPOWER-Cervical 1<\/strong> PD-1 + larotrectinib NTRK + dabrafenib+trametinib BRAF V600E raro; (e) outras mol\u00e9culas<\/strong> tisotumab vedotin Tivdak InnovativeBio Pfizer tissue factor TF ADC innovaTV-204+208 + nadofaragene firadenovec + balstilimab Agenus + nivolumab Opdivo CheckMate-358 + ipilimumab Yervoy + atezolizumab Tecentriq + dostarlimab Jemperli GSK MMR-d Lista C5.<\/p>\n

Cl\u00ednica com brachy+GOG 240+pembro+Tivdak madura escala brachy CTV-HSIL EMBRACE-II local control 80+%<\/strong> + escala GOG 240 pembro+chemo PFS extens\u00e3o<\/strong> + escala Tivdak innovaTV-204 ORR 24% 2L+<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

Tr\u00eas perfis de PGRSS por capacidade vulvar<\/h2>\n

Cl\u00ednica vulvar s\u00f3 A1.<\/strong> 1 fluxo. Custo mensal R$ 9.000-26.000<\/strong> mas perda de A4+brachy+E+sist\u00eamico.<\/p>\n

Cl\u00ednica vulvar A1 + A4 + cisplatina+RT.<\/strong> 3 fluxos. Custo mensal R$ 22.000-54.000<\/strong>, captura cirurgia + radio.<\/p>\n

Cl\u00ednica vulvar 5 fluxos completos.<\/strong> A1+A4+brachy+E+sist\u00eamico + integra\u00e7\u00e3o com servi\u00e7os hospitalares<\/a>. Custo mensal R$ 40.000-95.000<\/strong>, efic\u00e1cia 95%, ROI 800-2.500% via captura completa vulvar + GOG 240+KEYNOTE-826 + Tivdak ADC + GROINSS-V SLN.<\/p>\n

Os tr\u00eas erros que aparecem em cir oncol\u00f3gica vulvar<\/h2>\n

O primeiro \u00e9 a subdimensionamento Lista C5 imuno+ADC<\/strong>. Sem segrega\u00e7\u00e3o cisplatina+paclitaxel+bevacizumab+pembrolizumab+nivolumab+cemiplimab+tisotumab vedotin+atezolizumab+balstilimab+dostarlimab + Lista C5 = n\u00e3o-conformidade ANVISA RDC 222 + risco contamina\u00e7\u00e3o cruzada profissional + impacto financeiro.<\/p>\n

O segundo \u00e9 a mistura A1 CV escamoso + VIN + HPV-driven vs HPV-independent<\/strong>. Confunde rastreabilidade etiologia + impossibilita FIGO 2021+ISSVD 2015+ASCCP 2019 + risco indica\u00e7\u00e3o inadequada (HPV+ jovem vs HPV- p\u00f3s-menopausa lichen).<\/p>\n

O terceiro \u00e9 a falta de protocolo SLN GROINSS-V sentinela<\/strong>. Sem Tc-99m + ICG indocyanine green + DSL + ultrastaging IHC + GROINSS-V 1+2 omite IFL = perda fertility-sparing + risco linfedema 30-60% IFL completa desnecess\u00e1ria.<\/p>\n

A regula\u00e7\u00e3o de PGRSS vulvar no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com cir oncol\u00f3gica preservadora como prioridade. As institui\u00e7\u00f5es que estruturam fluxos completos desde o in\u00edcio \u2014 alinhadas com PGRSS cl\u00ednicas especializadas<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A INCA C\u00e2ncer Vulva<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS vulvar 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 CV carcinoma vulva escamoso 80%+HPV-driven 30-40% jovem+HPV-independent 60-70% lichen escleroso atr\u00f3fico+VIN diferenciado dVIN+adenoCa Bartholin 5%+melanoma 5-10%+sarcoma+Paget extramam\u00e1rio+ISSVD 2015+ASCCP 2019+FIGO 2021+CID C51, A4 vulvectomia radical Way+parcial+hemivulvectomia+skinning+laser CO2+IFL Inguinal-Femoral Lymphadenectomy superficial+profunda femoral+Cloquet+SLN GROINSS-V Tc-99m+ICG+ultrastaging+linfedema 30-60%+reconstru\u00e7\u00e3o flap V-Y+Limberg+pudendal+gracilis+VRAM, C brachy intersticial Iridium-192+Syed-Neblett+Martinez Universal+LDR\/HDR+ICRU-58\/89+CTV-HSIL EMBRACE-II+EBRT 50,4 Gy\/28+cisplatina concomitante GOG 205+IMRT+IGRT+CNEN-NN-3.05, E colposcopia vulvar \u00e1cido ac\u00e9tico+lugol Schiller+bi\u00f3psia 4mm punch+excisional+LEEP+laser CO2 OmniGuide, Lista C5 cisplatina+5-FU+paclitaxel+bevacizumab Avastin Genentech+pembrolizumab Keytruda Merck KEYNOTE-826\/A18+GOG 240+nivolumab Opdivo BMS CheckMate-358+ipilimumab Yervoy+cemiplimab Libtayo Regeneron PD-1 EMPOWER-Cervical 1+tisotumab vedotin Tivdak InnovativeBio Pfizer tissue factor TF ADC innovaTV-204\/208+nadofaragene firadenovec+balstilimab Agenus+atezolizumab Tecentriq+dostarlimab Jemperli RUBY-1.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS vulvar: vulvectomia + IFL + brachy + pembro GOG 240. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2296,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2712,3135,2070,3134],"class_list":["post-2297","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-cirurgia-oncologica","tag-ifl","tag-pembrolizumab","tag-vulvar"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2297","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2297"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2297\/revisions"}],"predecessor-version":[{"id":4371,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2297\/revisions\/4371"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2296"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2297"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2297"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2297"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}