A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms

Harter, Philipp; Sehouli, Jalid; Lorusso, Domenica; Reuß, Alexander; Vergote, Ignace; Marth, Christian; Kim, Jae Weon; Raspagliesi, Francesco; Lampe, Björn; Aletti, Giovanni; Meier, W.; Cibula, David; Mustea, Alexander; Mahner, Sven; Runnebaum, Ingo B.; Schmalfeldt, Barbara; Burges, Alexander; Kimmig, Rainer; Scambia, Giovanni; Greggi, Stefano; Hilpert, Felix; Hasenburg, Annette; Hillemanns, Peter; Giorda, Giorgio; Leffern, Ingo von; Schade‐Brittinger, Carmen; Wagner, Uwe; Bois, Andreas du

doi:10.1056/nejmoa1808424

Cited by 392 publications

(310 citation statements)

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“…It has been proposed earlier that systematic pelvic and paraaortic lymphadenectomy could facilitate cytoreduction (9), favor 5year overall-and progression-free survival in randomized clinical trials, and reduce recurrence rate (18). However, a study by Harter et al did not confirm the association of systematic pelvic and paraaortic lymphadenectomy with longer overall or progression-free survival, but has suggested that it contributes to a higher incidence of postoperative complications (19).…”

mentioning

confidence: 99%

Quality Indicators and Survival Outcome in Stage IIIB-IVB Epithelial Ovarian Cancer Treated at a Single Institution

Steinberga

Jansson

Sorbe

2019

In Vivo

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Background/Aim: To investigate the overall survival rate, quality indicators and treatment outcome in FIGO stage IIIB-IVB epithelial ovarian cancer at a University Hospital in Sweden between 2006 and 2015.Materials and Methods: A cohort of 110 patients was followed-up for 3-12 years after cancer diagnosis. Three main groups (primary surgery, neoadjuvant chemotherapy, palliative treatment), and six subgroups were defined according to treatment modality. Results: The mean age was 65 years. Patients were observed for a mean of 50 months. The total resection frequency was 83%. Significant differences in overall survival at 5 years were observed between the groups varying from 60% to 12%. Conclusion: Patient age, tumor stage and complete tumor removal at surgery were significant, independent prognostic factors of overall survival. Complication rate was a significant adverse prognostic factor in univariate analysis. Data discrepancy was observed between public quality reports and locally obtained data.

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confidence: 99%

Quality Indicators and Survival Outcome in Stage IIIB-IVB Epithelial Ovarian Cancer Treated at a Single Institution

Steinberga

Jansson

Sorbe

2019

In Vivo

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“…In the meantime, routine association of this procedure in cases with advanced stages will also prolong a more demanding and laborious surgical procedure by another hour and will predispose to significant postoperative complications, such as a larger amount of ascites and lymphorrhea. Moreover, the authors also demonstrated that performing systematic lymph node dissection in patients with clinically negative lymph nodes increases the risk of perioperative complications without improving the long-term outcome [21].…”

Section: Discussionmentioning

confidence: 97%

The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer

et al. 2020

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Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusions: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.

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“…In 2019, Harter et al [7] reported the results of the Lymphadenectomy in Ovarian Neoplasms (LION) trial in the New England Journal of Medicine. Based on their findings, systematic lymphadenectomy in patients with advanced ovarian cancer that lacked gross residual tumor and normal lymph nodes was not associated with improved PFS or OS relative to no lymphadenectomy.…”

Section: Ovary 1 Systemic Lymphadenectomy In Advanced Ovarian Cancermentioning

confidence: 99%

Major clinical research advances in gynecologic cancer in 2019

et al. 2020

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In 2019, 12 topics were selected as the major research advances in gynecologic oncology. Herein, we first opted to introduce the significant clinical activity of pembrolizumab in women with advanced cervical cancer based on the results of the phase 2 KEYNOTE-158 trial. Thereafter, we reviewed 5 topics, including systemic lymphadenectomy in the advanced stage with no gross residual tumor, secondary cytoreductive surgery in recurrent ovarian cancer according to the results of Gynecologic Oncology Group-213 trial, dose-dense weekly paclitaxel scheduling as first-line chemotherapy, the utility of intraperitoneal therapy in the advanced stage, and an update on poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of ovarian cancer. Additionally, we conducted a thorough review of emerging data from several clinical trials on PARP inhibitors according to drug, target population, and combined usage. For uterine corpus cancer, we reviewed adjuvant therapy for high-risk disease and chemotherapy in advanced/recurrent disease. For the field of radiation oncology, we discussed the utility of neoadjuvant chemotherapy added to chemoradiotherapy and the treatment of radiation-induced cystitis using hyperbaric oxygen. Finally, we discussed the use of individualized therapy with humanized monoclonal antibodies (trastuzumab emtansine and sacituzumab govitecan-hziy) and combination therapy (fulvestrant plus alpesilib, fulvestrant plus anastrozole, and ribociclib plus endocrine therapy) for women with advanced breast cancer.

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A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms

Cited by 392 publications

References 21 publications

Quality Indicators and Survival Outcome in Stage IIIB-IVB Epithelial Ovarian Cancer Treated at a Single Institution

Quality Indicators and Survival Outcome in Stage IIIB-IVB Epithelial Ovarian Cancer Treated at a Single Institution

The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer

Major clinical research advances in gynecologic cancer in 2019

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