Improved outcomes following the use of dose-dense paclitaxel-based neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

Abstract

after sentinel lymph node (SLN) biopsy in preoperative low-grade endometrial cancers. (2) To prospectively evaluate the ability of intraoperative (IO) assessment to predict the final pathologic size of an endometrial malignancy. Methods: From March to August 2015, patients with low-grade endometrial cancer who underwent minimally invasive surgery with SLN injection were included in a prospective study. Institutional management of low-grade endometrial cancer during the study period was SLN mapping and biopsy followed by total laparoscopic hysterectomy/bilateral salpingo-oophorectomy with frozen section evaluation of the uterus; additional lymph node sampling was based on Mayo criteria and surgeon preference. After hysterectomy, the uterus was bivalved and the largest diameter of tumor was recorded by the surgical team. After the frozen section report, including a tumor size assessment by pathology, the surgeon completed an intraoperative questionnaire on factors influencing the decision to perform or withhold FPL. Results: All patients underwent injection for SLN mapping. Of 26 patients, 19 (73%) underwent bilateral mapping, 5 (19%) unilateral, and 2 (8%) had no mapping. Four patients (15%) underwent FPL, with the following reasons listed: tumor size greater than 2 cm (n = 3), depth of invasion (n = 2), failure of SLN mapping (n = 2), grade (n = 1), and age greater than 70 years (n = 1). Twenty-one patients did not undergo FPL; the reasons cited were low grade (81%), invasion less than 1/2 (81%), tumor size (76%), SLN mapping (71%), age (14%), body mass index (10%), poor visualization (5%), patient preference (5%), and comorbidities (5%). Using Mayo criteria, the final pathologic tumor size would have stratified a few patients to different management (n = 5 [19%], based on intraoperative surgeon assessment, and n = 4 [15%], based on intraoperative pathologist assessment). Conclusions: Intraoperative assessment of tumor size by the surgeon or pathologist incorrectly classifies risk of lymph node metastasis using the Mayo criteria in 1 of 5 cases. A prospective assessment of intraoperative factors that affect the decision to perform FPL in apparent early-stage EC demonstrates significant variability at one institution. These data highlight the need to develop a consensus algorithm that integrates SLN mapping into clinical decisions to proceed to FPL in endometrial cancer.