Retrospective Analysis of Selective Lymphadenectomy in Apparent Early-Stage Endometrial Cancer

Cragun, Janiel M.; Havrilesky, Laura J.; Calingaert, Brian; Synan, Ingrid S.; Secord, Angeles Alvarez; Soper, John T.; Clarke‐Pearson, Daniel L.; Berchuck, Andrew

doi:10.1200/jco.2005.04.144

Cited by 401 publications

(263 citation statements)

References 16 publications

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“…Despite a probable selection bias for lymphadenectomy in women deemed pre-operatively at high clinical risk for extrauterine disease, the proportion of women undergoing surgical staging lymphadenectomy were similar among nonobese and obese women. Our median nodal yield of 13 nodes may at first seem low, but is comparable to the 11 node criterion suggested by Cragun et al 23 in their evaluation of selective lymphadenectomy in endometrial cancer.…”

Section: Commentsupporting

confidence: 84%

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Martra

Kunos

Gibbons

et al. 2008

American Journal of Obstetrics and Gynecology

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Objective-To determine the impact of patient weight on frequency of surgical staging lymphadenectomy and pelvic radiation. Adverse effects, disease relapse, and survival outcomes were investigated.Study Design-Records of 766 women undergoing surgery for presumed corpus-confined endometrial cancer were reviewed. Body mass index (BMI) was calculated categorizing women as obese (BMI ≥ 30) or nonobese (BMI < 30). Radiation-related toxicity was retrospectively scored. Median duration of follow-up was 38 months. Chi-square, logistic regression, correlation, KaplanMeier and Cox multivariate proportional hazards were used for analysis.Results-Lymphadenectomy was completed as often in nonobese as obese women (p=0.24). Adjuvant pelvic radiation treatment was administered more often in nonobese women (p=0.01). Among 681 women with endometrioid histopathology, four-year cancer-related survival in obese women was 10 percent higher than all cause mortality, compared to 6 percent in nonobese women.Conclusion-Obesity was not a barrier to lymphadenectomy, but did influence adjuvant pelvic radiation use.CORRESPONDING AUTHOR and REPRINT REQUESTS: Vivian von Gruenigen, MD,

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Section: Commentsupporting

confidence: 84%

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Martra

Kunos

Gibbons

et al. 2008

American Journal of Obstetrics and Gynecology

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“…extrafascial hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and para-aortic lymph node dissection via either laparotomy or minimally invasive approach [1][2][3][4]. On the other hand, although the performance of lymphadenectomy is required by the International Federation of Gynecologic and Obstetrics [FIGO] staging system [5,6], there is yet no consensus about whether and which kind of lymphadenectomy should be carried out in the surgical staging of this malignancy [7][8][9][10][11][12]. Outside clinical trials, this surgical procedure is usually performed in women with poorly differentiated grade (G 3 ) (assessed on preoperative biopsy) and/or or deep myometrial invasion (assessed on preoperative magnetic resonance imaging or intra-operative sections).…”

Section: Introductionmentioning

confidence: 99%

Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Gadducci

Cosio

Landoni

et al. 2014

Gynecologic Oncology

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• Adjuvant chemotherapy reduces the risk of distant recurrences in patients with high-risk, early-stage endometrial cancer with negative pelvic nodes.• The sequential administration of adjuvant chemotherapy and radiotherapy achieves excellent local and distant control of disease in this clinical settings. Objectives. The purpose of this retrospective study was to assess the clinical outcome of patients with highrisk, early-stage endometrioid endometrial cancer (stage Ib or II with myometrial invasion N 50%, grade 2-3). a b s t r a c t a r t i c l e i n f oMethods. We assessed 192 patients who underwent hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, had histologically negative pelvic nodes, and had negative CT findings for aortic node involvement.Results. Tumor relapsed in 36 patients after a median time of 21.2 months. The recurrence was vaginal in 7 (19.4%), distant in 16 (44.4%), aortic in 8 (22.2%), and involved multiple sites in 5 (13.9%). There was a trend to a lower vaginal recurrence rate in the 143 patients who received adjuvant radiotherapy (+chemotherapy) compared with the 46 who did not (2.1% versus 8.7%). Distant or aortic recurrences were lower in the 37 patients who received adjuvant chemotherapy (+radiotherapy) than in the 152 who did not (2.7% versus 18.4%, p = 0.02). Of the 29 patients who received sequential adjuvant chemotherapy and radiotherapy, none developed local recurrence and only one had distant recurrence. There was a trend for a better 5-year progression-free survival and overall survival for the patients who received chemotherapy (+ radiotherapy) compared with those who did not (86.0% versus 71.3%, and 92.3% versus 75.6%, respectively).Conclusions. Our data appear to suggest that adjuvant chemotherapy reduces the risk of distant or aortic recurrences and that sequential adjuvant chemotherapy and radiotherapy achieve an excellent local and distant control of disease in these clinical settings.

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“…The incidence of metastases to the pelvic LNs in patients with corpus-confined EC who undergo lymphadenectomy varies between 5% and 18% [15][16][17][18] . Para aortic LN metastases are observed between 3 to 11% of patients with EC depending on primary tumoral characteristics.…”

Section: Locations Of Lymph Node Metastasismentioning

confidence: 99%

Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

Koskas¹,

Rouzier²,

Amant³

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 FIGO classification.Radiological examination such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming more and more valuable to exclude lymph node metastasis in low risk groups and biomarkers could help to identify patients with high risk lymph node metastatic probability.The therapeutic role of lymph node dissection remains debated. Several endpoints can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer.Firstly, we compare survival according to the realization, the extent and the numbers of nodes removed during lymphadenectomy. Secondly, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Thirdly, we analyze the surgical complication rate after pelvic lymphadenectomy.

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Retrospective Analysis of Selective Lymphadenectomy in Apparent Early-Stage Endometrial Cancer

Abstract: These data add to the literature documenting the possible therapeutic benefit of selective lymphadenectomy in management of patients with apparent early-stage endometrial cancer.

Cited by 401 publications

References 16 publications

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

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