Systematic use of pelvic lymphadenectomy (removal of the lymph nodes) does not improve diseasefree or overall survival in women with earlystage endometrial cancer, according to a randomized trial published on the internet November 25 in the Journal of the National Cancer Institute.

The first range of metastasis for endometrial cancer is lots the pelvic lymph nodes. However, few prospective studies have examined whether systematic removal of the pelvic lymph nodes improves patient outcomes.

To find out, Pierluigi Benedetti Panici, M.D., of the La Sapienza University in Rome and colleagues conducted a randomized controlled trial in which women with stage I endometrial cancer were assigned to have a authoritative hysterectomy and ovary removal with or out lymphadenectomy.

With a median followup of four years, there was no difference in patient outcomes surrounded by the two arms. Thirtyfour (12.9 percent) of the 264 patients in the lymphadenectomy group and 33 (13.2 percent) of the 250 patients in the clout group had disease recurrence. The median deviation to disease recurrence was 14 months in the lymphadenectomy arm and 13 months in the audit arm. Overall fiveyear survival estimates were 86 percent for the lymphadenectomy arm and 90 percent for the nonlymphadenectomy.

Surgical staging of the disease was improved with the systematic use of lymphadenectomy. A total of 13.3 percent of the women in the lymphadenectomy arm were set up to have disease spread to pelvic lymph nodes, compared with 3.2 percent of the women in the power arm. The investigators get going that although lymphadenectomy was not statistically significantly associated with improved survival, disease spread to the nodes was associated with poorer survival.

“Therefore, lymph¬adenectomy maintained its importance in determining a patients prognosis and in tailoring adjuvant therapies,” the authors conclude.

In an accompanying editorial, Christine Walsh, M.D., and Beth Karlan, M.D., of the CedarsSinai Medical Center in Los Angeles note that these new knowledge are consistent with the one other randomized trial that examined the impact of lymphadenectomy on survival.

“These results bust the myth that is based on previous retrospective studies that lymphadenectomy, in and of itself, provides therapeutic ben¬efit and survival eminence in endometrial cancer,” the editorialists write. “Yet, that trial continues to support the notion that lymphadenectomy can provide chief prognostic orientation and can utility guide adjuvant treatment recommendations.”

editorial adapted by Medical News Today from original press release.

Citation

spread Benedetti Panici P, et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in EarlyStage Endometrial Carcinoma Randomized Clinical Trial. Journal of the National Cancer Institute 2008; 10017071716

Editorial Walsh CS, Karlan BY. Lymphadenectomys Role in Early Endometrial Cancer Prognostic or Therapeutic? Journal of the National Cancer Institute 2008; 10016601661

The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. surf the Journal on the web at jnci.oxfordjournals.org

Source Liz Savage
Journal of the National Cancer Institute