Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma

Başaran, Derman; Bruce, S.F.; Mueller, J.J.; Broach, Vance; Cadoo, K.A.; Soslow, R.A.; Abu-Rustum, N.R.; Leitao, Mario M.

doi:10.1016/j.ygyno.2019.04.346

Cited by 7 publications

(12 citation statements)

References 16 publications

(23 reference statements)

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“…En effet, les curages sont à risque de complications per-opératoires (plaies d’uretère ou vasculaire) et post-opératoire (lymphocèle, douleur, surinfection) pouvant parfois retarder voire empêcher la réalisation d’un traitement adjuvant. De plus, l’intérêt des curages sur la survie est remis en question avec de nombreux articles apportant des informations discordantes [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] . Certaines études se sont intéressées à des méthodes alternatives pour réaliser une stadification.…”

Section: Discussionunclassified

“…Soliman et al [32] ont retrouvé chez des patientes présentant un carcinome endométrial de haut risque, un bon taux de détection des métastases ganglionnaires avec le ganglion sentinelle (95 %). De plus en plus d’études font prendre une place importante au ganglion sentinelle dans la stadification des carcinomes à haut risque notamment grâce à l’ultrastaging et à l’immunofluorescence [32] , [33] , [34] , [35] . Dans les recommandations Américaines du NCCN de 2018, la technique du ganglion sentinelle pour les carcinomes à haut risque est une option en alternative au curage ganglionnaire complet [36] .…”

Section: Discussionunclassified

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Évaluation de l’application des recommandations des cancers de l’endomètre de type 2 : étude rétrospective multicentrique

et al. 2020

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Introduction Les carcinomes de l’endomètre de type 2 sont des cancers peu fréquents et de mauvais pronostique. Il existe très peu d’étude analysant leur prise en charge. L’objectif de l’étude était d’étudier la prise en charge des carcinomes de type 2 dans nos centres en évaluant l’application des recommandations. Matériel et méthode Il s’agit d’une étude multicentrique rétrospective enregistrant les cancers de l’endomètre de type 2 pris en charge de janvier 2009 à décembre 2019. Les analyses ont été adaptées aux dernières recommandations françaises appliquées par rapport à l’année de prise en charge. Résultats Soixante-quatorze carcinomes de type 2 ont été analysés dans dix centres: 34 carcinosarcomes (45,9 %), 29 carcinomes séreux (39,2 %), neuf carcinomes à cellules claires (12,2 %) et deux carcinomes indifférenciés (2,7 %). Lors de la prise en charge initiale, les recommandations étaient appliquées dans 45,9 % des cas. Le principal motif de non-application des recommandations était la non-réalisation d’une stadification ganglionnaire chirurgicale pour 20 patientes (57,1 %). Lors de la prise en charge adjuvante, les recommandations étaient appliquées dans 37,8 % des cas. Le principal motif de non-application des recommandations était la non-réalisation d’une restadification ganglionnaire chirurgicale ou radiologique pour 25 patientes (67,6 %). Discussion L’applicabilité des recommandations pour la prise en charge des carcinomes de type 2 reste difficile en raison de l’âge élevé et des comorbidités des patientes notamment pour la réalisation d’une stadification chirurgicale ganglionnaire pelvienne et lombo-aortique. L’utilisation de nouvelles techniques de stadification permettrait de mieux sélectionner les indications de curages ganglionnaires.

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Section: Discussionunclassified

Évaluation de l’application des recommandations des cancers de l’endomètre de type 2 : étude rétrospective multicentrique

et al. 2020

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“…Although randomized data supporting this approach are lacking, the rarity of this disease makes accrual to clinical trials challenging. Meanwhile, the relatively high rate of DM despite the use of aggressive adjuvant therapy, even in patients with early-stage disease, highlights the need for additional advances for these patients, such as improved surgical techniques 27 and the use of targeted agents like trastuzumab. 28 Finally, inclusion of these patients in larger randomized trials for endometrial cancer is needed, as has been previously suggested, 29 to help improve treatment strategies for this aggressive disease.…”

Section: Discussionmentioning

confidence: 99%

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

Arden

Marvin

Hong

et al. 2020

Advances in Radiation Oncology

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Purpose Uterine serous carcinoma (USC) is a rare but aggressive endometrial cancer histology. We reviewed outcomes for patients with USC to identify the best adjuvant treatment strategy. Methods and Materials We retrospectively identified 162 patients with The International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA USC treated at our institution. Baseline characteristics, treatment details, clinical outcomes, and toxicity data were recorded. Results Median follow-up was 3.4 years (0.3-26 years). A variety of adjuvant therapy strategies were employed: 14% no adjuvant therapy, 28% radiation alone, 15% chemotherapy alone, and 43% combined chemotherapy and radiation. Distant metastasis was the most common type of recurrence (37% at 5 years). For patients with stage I-IVA disease, there were no significant differences in outcomes by treatment type. For patients with stage I-II disease (70% of the cohort), disease-free survival was significantly higher after chemotherapy (alone or with radiation therapy, P = .005) and after combined chemotherapy and radiation compared with all other treatments ( P = .025). Toxicity outcomes were favorable, with minimal grade 3 and no grade 4 or 5 events. Conclusions Patients with USC experience high rates of recurrence and mortality. Distant metastasis is the most common pattern of failure for all stages. For patients with early-stage disease, combined chemotherapy and radiation improves 5-year disease-free survival compared with either single adjuvant treatment alone or no adjuvant treatment. The relatively large group of patients with USC included in this study may account for our ability to detect this improvement whereas clinical trials have failed to do so, possibly owing to the relatively small percentages of patients with USC enrolled.

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“…The impact of the SLN technique on oncologic outcome has been mainly described in retrospective series [29][30][31][32][33][34][35]. This series suggests that, using the SLN algorithm [20], oncologic outcomes will not be affected [29][30][31][32][33][34][35][36]. However, prospective data are still lacking.…”

Section: Oncologic Outcomes Of Slnmentioning

confidence: 99%

“…A few retrospective studies described the impact of SLN on oncologic outcomes in intermediate-and high-risk endometrial cancers [30][31][32][33][34][35]. Another retrospective series by MSKCC and Mayo Clinic compared progression-free survival (PFS) and OS in 176 patients with endometrioid endometrial cancers and myometrial invasion ≥50% [33].…”

Section: Oncologic Outcomes Of Slnmentioning

confidence: 99%

Role of sentinel lymph node in endometrial cancer: rationale and surgical aspects, a review of the literature

Marino¹,

Grassi²,

Martino³

et al. 2022

EJGO

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Endometrial carcinoma is the most common gynecological cancer in Europe, with 130,000 new cases per year, and the incidence has been rising with aging and increased obesity of the population. Most women with endometrial cancer will present with early-stage disease, with a tumor confined to the uterus and without metastasis, and the first approach is surgery. Approximately 10% to 15% of these patients have a metastatic nodal disease, which is why guidelines have always emphasized the importance of lymphadenectomy to stratify the risk and tailor adjuvant treatment. However, comprehensive lymphadenectomy is related to significant morbidity and seems not to improve either progression-free or overall survival in these patients. Lymphatic mapping with sentinel lymph node biopsy has emerged as an alternative and an optimal compromise instead of systematic lymphadenectomy. This review presents the current evidence supporting sentinel lymph node biopsy in patients with endometrial cancer.

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Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma

Abstract: Objectives-The objective of our study was to assess survival among patients with uterine serous carcinoma (USC) undergoing sentinel lymph node (SLN) mapping alone versus patients undergoing systematic lymphadenectomy (LND).

Cited by 7 publications

References 16 publications

Évaluation de l’application des recommandations des cancers de l’endomètre de type 2 : étude rétrospective multicentrique

Évaluation de l’application des recommandations des cancers de l’endomètre de type 2 : étude rétrospective multicentrique

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

Role of sentinel lymph node in endometrial cancer: rationale and surgical aspects, a review of the literature

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