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Obermair A. Sentinel lymph node staging versus lymphadenectomy in high risk patients: is there sufficient evidence to change practice? Int J Gynecol Cancer 2023; 33:1021-1022. [PMID: 37400122 DOI: 10.1136/ijgc-2023-004662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Andreas Obermair
- University of Queensland, Queensland Centre for Gynaecological Cancer Research, Herston, Queensland, Australia
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Iavazzo C, Psomiadou V, Fotiou A, Vrachnis N. Cost efficacy of sentinel lymph node biopsy in endometrial cancer patients: Re: Uptake and outcomes of sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer: Re: Uptake and outcomes of sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer. BJOG 2023; 130:426-427. [PMID: 35315201 DOI: 10.1111/1471-0528.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alexandros Fotiou
- 3rd Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Nikolaos Vrachnis
- 3rd Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece.,Department of Vascular Biology, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
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Burg LC, Kruitwagen RFPM, de Jong A, Bulten J, Bonestroo TJJ, Kraayenbrink AA, Boll D, Lambrechts S, Smedts HPM, Bouman A, Engelen MJA, Kasius JC, Bekkers RLM, Zusterzeel PLM. Sentinel Lymph Node Mapping in Presumed Low- and Intermediate-Risk Endometrial Cancer Management (SLIM): A Multicenter, Prospective Cohort Study in The Netherlands. Cancers (Basel) 2022; 15:cancers15010271. [PMID: 36612266 PMCID: PMC9818361 DOI: 10.3390/cancers15010271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
The aim was to investigate the incidence of sentinel lymph node (SLN) metastases and the contribution of SLN mapping in presumed low- and intermediate-risk endometrial cancer (EC). A multicenter, prospective cohort study in presumed low- and intermediate-risk EC patients was performed. Patients underwent SLN mapping using cervical injections of indocyanine green and a minimally invasive hysterectomy with bilateral salpingo-oophorectomy. The primary outcome was the incidence of SLN metastases, leading to adjusted adjuvant treatment. Secondary outcomes were the SLN detection rate and the occurrence of complications. Descriptive statistics and univariate general linear model analyses were used. A total of 152 patients were enrolled, with overall and bilateral SLN detection rates of 91% and 61%, respectively. At final histology, 78.9% of patients (n = 120) had truly low- and intermediate-risk EC. Macro- and micro-metastases were present in 11.2% (n = 17/152), and three patients had isolated tumor cells (2.0%). Nine patients (5.9%) had addition of adjuvant radiotherapy based on SLN metastases only. In 2.0% of patients with high-risk disease, adjuvant therapy was more limited due to negative SLNs. This study emphasizes the importance of SLN mapping in presumed early-stage, grade 1 and 2 EC, leading to individualized adjuvant management, resulting in less undertreatment and overtreatment.
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Affiliation(s)
- Lara C. Burg
- Department of Gynaecological Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-61-1714-781
| | - Roy F. P. M. Kruitwagen
- Department of Gynaecological Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Annemarie de Jong
- Department of Gynaecological Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Tijmen J. J. Bonestroo
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, 6800 TA Arnhem, The Netherlands
| | - Arjan A. Kraayenbrink
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, 6800 TA Arnhem, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynaecology, Catharina Hospital, 5602 ZA Eindhoven, The Netherlands
| | - Sandrina Lambrechts
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Huberdina P. M. Smedts
- Department of Obstetrics and Gynaecology, Amphia Hospital, 4800 RK Breda, The Netherlands
| | - Annechien Bouman
- Department of Obstetrics and Gynaecology, Deventer Hospital, 7400 GC Deventer, The Netherlands
| | - Mirjam J. A. Engelen
- Department of Obstetrics and Gynaecology, Zuyderland Medical Center, 6130 MB Heerlen and Sittard-Geleen, The Netherlands
| | - Jenneke C. Kasius
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), 1100 DD Amsterdam, The Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Catharina Hospital, 5602 ZA Eindhoven, The Netherlands
| | - Petra L. M. Zusterzeel
- Department of Gynaecological Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Applications and Safety of Sentinel Lymph Node Biopsy in Endometrial Cancer. J Clin Med 2022; 11:jcm11216462. [DOI: 10.3390/jcm11216462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Lymph node status is important in predicting the prognosis and guiding adjuvant treatment in endometrial cancer. However, previous studies showed that systematic lymphadenectomy conferred no therapeutic values in clinically early-stage endometrial cancer but might lead to substantial morbidity and impact on the quality of life of the patients. The sentinel lymph node is the first lymph node that tumor cells drain to, and sentinel lymph node biopsy has emerged as an acceptable alternative to full lymphadenectomy in both low-risk and high-risk endometrial cancer. Evidence has demonstrated a high detection rate, sensitivity and negative predictive value of sentinel lymph node biopsy. It can also reduce surgical morbidity and improve the detection of lymph node metastases compared with systematic lymphadenectomy. This review summarizes the current techniques of sentinel lymph node mapping, the applications and oncological outcomes of sentinel lymph node biopsy in low-risk and high-risk endometrial cancer, and the management of isolated tumor cells in sentinel lymph nodes. We also illustrate a revised sentinel lymph node biopsy algorithm and advocate to repeat the tracer injection and explore the presacral and paraaortic areas if sentinel lymph nodes are not found in the hemipelvis.
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Wang T, Xu Y, Shao W, Wang C. Sentinel Lymph Node Mapping: Current Applications and Future Perspectives in Gynecology Malignant Tumors. Front Med (Lausanne) 2022; 9:922585. [PMID: 35847801 PMCID: PMC9276931 DOI: 10.3389/fmed.2022.922585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022] Open
Abstract
The sentinel lymph nodes (SLNs) is a group of lymph nodes initially involved in the metastatic spread of cancer cells. SLN mapping refers to intraoperative localization and biopsy of SLNs with specific tracers to assess lymph node metastases. It is widely used in a variety of tumor surgeries for its high sensitivity and high negative predictive value. In the evaluation of the status of lymph node metastases in gynecological malignancies, it has received increasingly more attention due to its minor invasiveness, few complications, and high diagnosis rate. The National Comprehensive Cancer Network (NCCN) guidelines provide an excellent introduction to the indications and methods of SLN techniques in vulvar, cervical, and endometrial cancers, but they provide little explanation about some specific issues. In this review, we summarize different dyes and injection methods and discuss the indications of application and the clinical trials of SLN mapping in gynecological malignant tumors, aiming to provide a reference for the rational application of sentinel techniques in gynecology malignant tumors before relevant guidelines are updated.
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Forsse D, Barbero ML, Werner HMJ, Woie K, Nordskar N, Berge Nilsen E, Ellstrøm Engh M, Vistad I, Rege A, Sævik-Lode M, Andreasen S, Haldorsen IS, Trovik J, Krakstad C. Longitudinal effects of adjuvant chemotherapy and lymph node staging on patient-reported outcomes in endometrial cancer survivors: a prospective cohort study. Am J Obstet Gynecol 2022; 226:90.e1-90.e20. [PMID: 34400137 DOI: 10.1016/j.ajog.2021.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most patients with endometrial cancer with localized disease are effectively treated and survive for a long time. The primary treatment is hysterectomy, to which surgical staging procedures may be added to assess the need for adjuvant therapy. Longitudinal data on patient-reported outcomes comparing different levels of primary treatment are lacking, especially when adjuvant radiotherapy is omitted. OBJECTIVE We assessed the impact of lymphadenectomy and adjuvant chemotherapy on patient-reported symptoms, function, and quality of life. We hypothesized that these treatment modalities would substantially affect patient-reported outcomes at follow-up. STUDY DESIGN We prospectively included patients with endometrial cancer enrolled in the ongoing MoMaTEC2 study (ClinicalTrials.gov Identifier: NCT02543710). Patients were asked to complete the patient-reported outcome questionnaires European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EN24 preoperatively and at 1 and 2 years of follow-up. Functional domains and symptoms were analyzed for the whole cohort and by treatment received. To assess the effect of the individual treatment modifications, we used mixed regression models. RESULTS Baseline data were available for 448 patients. Of these patients, 339 and 219 had reached 1-year follow-up and 2-year follow-up, respectively. Treatment included hysterectomy (plus bilateral salpingo-oophorectomy) alone (n=177), hysterectomy and lymph node staging without adjuvant therapy (n=133), or adjuvant chemotherapy irrespective of staging procedure (n=138). Overall, patients reported improved global health status and quality of life (+9 units; P<.001), increased emotional and social functioning, and increased sexual interest and activity (P<.001 for all) from baseline to year 1, and these outcomes remained stable at year 2. Means of functional scales and quality of life were similar to age- and sex-weighted reference cohorts. Mean tingling and numbness and lymphedema increased after treatment. The group who received adjuvant chemotherapy had a larger mean reduction in physical functioning (-6 vs +2; P=.002) at year 1, more neuropathy (+30 vs +5; P<.001; year 1) at years 1 and 2, and more lymphedema at year 1 (+11 vs +2; P=.007) than the group treated with hysterectomy and salpingo-oophorectomy only. In patients not receiving adjuvant chemotherapy, patient-reported outcomes were similar regardless of lymph node staging procedures. Adjuvant chemotherapy independently increased fatigue, lymphedema, and neuropathy in mixed regression models. CONCLUSION Patients with endometrial cancer receiving adjuvant chemotherapy reported significantly reduced functioning and more symptoms up to 2 years after treatment. For patients treated by surgery alone, surgical staging did not seem to affect the quality of life or symptoms to a measurable degree at follow-up. Therefore, subjecting patients to lymph node removal to tailor adjuvant therapy seems justified from the patient's viewpoint; however, efforts should increase to find alternatives to traditional chemotherapy.
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Affiliation(s)
- David Forsse
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Mark L Barbero
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Henrica M J Werner
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Kathrine Woie
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Nina Nordskar
- Department of Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Berge Nilsen
- Department of Obstetrics and Gynecology, Helse Stavanger-Stavanger University Hospital, Stavanger, Norway
| | - Marie Ellstrøm Engh
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway; Faculty Division Akershus University Hospital, University of Oslo
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway; Clinical Institute II, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Astri Rege
- Department of Obstetrics and Gynecology, District General Hospital of Førde, Førde, Norway
| | - Margaret Sævik-Lode
- Department of Obstetrics and Gynecology, Helse Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Stine Andreasen
- Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway
| | - Ingfrid S Haldorsen
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Helse Bergen, Haukeland University Hospital, Bergen, Norway; Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Camilla Krakstad
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
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