GOG 244, the lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients

Abstract

Objectives: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244.Methods: Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed. Results:Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n=247), 35% (n=48), and 43% (n=18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a Carlson et al.

Preoperative PET/CT does not accurately detect extrauterine disease in patients with newly diagnosed high‐risk endometrial cancer: A prospective study

“…17 Data from the randomized, prospective multicenter study (SENTICOL-II) demonstrated a reduction in surgical and postoperative morbidity associated with sentinel lymph node biopsy compared with comprehensive lymphadenectomy in patients with cervical cancer. GOG 244, the lymphedema and gynecologic cancer (LEG) study, reported a lymphedema rate of 34% in 733 patients with endometrial cancer who underwent a lymph node dissection.…”

“…GOG 244, the lymphedema and gynecologic cancer (LEG) study, reported a lymphedema rate of 34% in 733 patients with endometrial cancer who underwent a lymph node dissection. 17 Data from the randomized, prospective multicenter study (SENTICOL-II) demonstrated a reduction in surgical and postoperative morbidity associated with sentinel lymph node biopsy compared with comprehensive lymphadenectomy in patients with cervical cancer. 18 However, to the best of our knowledge, there is not yet similar highquality evidence establishing the incidence of morbidity after sentinel lymph node biopsy in patients with endometrial cancer.…”

Lower extremity lymphedema in patients with gynecologic malignancies

“…Larger studies comparing patient-reported outcomes to objective metrics are still needed 13. The Gynecologic Oncology Group study 244 (GOG 244), also known as the Lymphedema and Gynecologic (LEG) cancer study, is a prospective multicenter trial which examines both objective measurement and patient-reported surveys to better our understanding of the true burden of lymphedema in patients with gynecologic malignancy 19…”

Robotic sentinel node mapping in clinical stage 1 endometrial cancer using methylene blue dyes using the robotic platform

“…Comprehensive lymphadenectomy can result in significant chronic long‐term leg edema impairing patients' quality of life . Efforts has been made to limit the extent of nodal dissection to minimize long‐term lymphedema side effects by the application of sentinel lymph node (SLN) mapping algorithm with success .…”