Lymphadenectomy and adjuvant therapy in endometrial carcinoma: role of adjuvant chemotherapy

Abstract

To evaluate the therapeutic benefit of lymphadenectomy and adjuvant therapy, in particular chemotherapy, we retrospectively analysed survival rates and patterns of recurrence of endometrioid adenocarcinoma in 106 patients who underwent surgery including retroperitoneal lymphadenectomy. Adjuvant chemotherapy was administered to 46 patients (42 received a platinumbased regimen) and pelvic irradiation to 12. The 5-year survival rate of 23 patients with lymph node metastasis was worse than that of patients without lymph node metastasis (60% vs 96%, P50.0001). Recurrence was observed in 14 patients (10 patients with chemotherapy, two with irradiation, and two without adjuvant therapy); the first site of recurrence was in distant sites in 12 patients; recurrence in the pelvic sidewall or exclusively in lymph nodes was not observed. The 5-year survival rate of 18 patients with lymph node metastasis treated with chemotherapy, was 61% including all 14 with macroscopically positive nodes and all nine with paraaortic metastasis. Of seven patients with bulky positives nodes, three patients with bulky paraaortic nodes died of the disease, three of the four patients with bulky pelvic but without bulky paraaortic nodes had no recurrence. In summary, lymphadenectomy may afford a survival benefit via the debulking of macroscopically positive nodes, and the predominance of distant recurrences suggests that chemotherapy is a suitable choice as an adjuvant therapy in endometrial carcinoma after lymphadenectomy.

Prognostic discrimination of subgrouping node-positive endometrioid uterine cancer: location vs nodal extent

“…Prior studies have shown a wide variation in survival based on lymph node location. In several series patients with involvement of pelvic lymph nodes only had nonsignificant differences in survival compared with those with positive paraaortic lymph nodes ( McMeekin et al , 2001 ; Mariani et al , 2002 ; Otsuka et al , 2002 ; Havrilesky et al , 2005 ; Hoekstra et al , 2009 ; Lewin et al , 2010 ; Todo et al , 2011 ). In other series better survival was noted for patients with pelvic nodes ( Morrow et al , 1991 ; Hirahatake et al , 1997 ; Yokoyama et al , 1997 ; Watari et al , 2005 ; Fujimoto et al , 2007 ; Karube et al , 2010 ; Lewin et al , 2010 ).…”

Treatment outcomes and complications in FIGO stage IIIC and IVB endometrioid endometrial cancer patients presenting as nodal spreads following systematic lymphadenectomy and adjuvant therapy

“…23 Some authors in Japan evaluated the therapeutic benefit of lymphadenectomy and adjuvant chemotherapy in node-positive endometrioid EC patients and grade 3 EC patients. 8,24 They suggested that disease recurrence occurs predominantly outside the pelvis and chemotherapy may be a suitable choice for adjuvant therapy in EC patients following systematic lymphadenectomy. Given the results of these trials, we suggest adjuvant chemotherapy following systematic lymphadenectomy in FIGO stage IIIC and IV endometroid EC patients presenting primarily as nodal spreads.…”

“…Therefore, pelvic radiotherapy did not appear to be effective in reducing extrapelvic recurrence. 8 Also, pelvic radiotherapy frequently causes gastrointestinal complications including small bowel obstruction after para-aortic lymphadenectomy. 28,29 If appropriate chemotherapy is given after complete lymphadenectomy in patients with LN metastasis, pelvic radiotherapy could be reserved for possible pelvic recurrence in the future.…”

“…Most disease recurrence in EC patients following systematic lymphadenectomy was in distant sites and chemotherapy may be a suitable choice for adjuvant therapy in endometrioid EC patients following lymphadenectomy. 8 Moreover, patients with pelvic radiotherapy following systematic lymphadenectomy may experience severe adverse events including leg lymphedema and gastrointestinal complications. [9][10][11] Therefore, it would be meaningful to select type I EC patients with metastases only to the LNs and analyze the treatment-related complications and therapeutic effects of adjuvant chemoradiation or chemotherapy following systematic lymphadenectomy in endometrioid EC patients primarily presenting as nodal spreads.…”

La lymphadénectomie dans les cancers de l’endomètre de stade I

“…Otsuka [35] utilise un argument classique mais discutable pour justifier la cytoréduction : le pronostic des cas N+ macroscopiques rejoint après curage ganglionnaire « théra-peutique » celui des N+ microscopiques. Indépendamment de cet argument, on sait que l'irradiation externe est mal adaptée au contrôle des adénomégalies.…”