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| |  More Complete Removal of Lymph Nodes Improves Survival in Endometrial Cancer NEW YORK -- February 24, 2010 -- A complete, systematic removal of both pelvic lymph nodes and para-aortic lymph nodes, improves survival compared with removal of just the pelvic lymph nodes, in patients at medium to high risk of cancer recurrence. Thus the complete procedure should be recommended to these patients, according to a study published online first and appearing in an upcoming issue of The Lancet. Previous studies have shown that pelvic lymphadenectomy does not have any therapeutic benefit for endometrial cancer. In the current study, Noriaki Sakuragi, MD, and Yukiharu Todo, MD, Department of Gynaecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan, and colleagues aimed to establish whether complete, systematic lymphadenectomy, including the para-aortic lymph nodes, should be part of surgical therapy for patients at intermediate and high risk of recurrence. The SEPAL study involved 671 patients with endometrial cancer who had been treated with complete, systematic pelvic lymphadenectomy (n = 325) or combined pelvic and para-aortic lymphadenectomy (n = 346) at 2 tertiary centres in Japan (January 1986-June 2004). Patients at intermediate or high risk of recurrence were offered adjuvant radiotherapy or chemotherapy. The primary outcome measure was overall survival. The researchers showed that risk of death in the complete procedure group was around half that in the pelvic lymphandecotomy-only group. This association was also recorded in 407 patients at intermediate or high risk or cancer recurrence, but overall survival was not related to lymphadenectomy type in low-risk patients. In patients with intermediate or high risk of recurrence, the complete procedure reduced the risk of death compared with pelvic lymphadenectomy by 56%. Analysis of 328 patients with intermediate or high risk who were treated with adjuvant radiotherapy or chemotherapy showed that risk of death decreased with the complete procedure by 52%, and with adjuvant chemotherapy by 41%, independently of one another. “Findings from the SEPAL study have shown that para-aortic lymphadenectomy has survival benefits for patients at intermediate or high risk of recurrence, and that pelvic lymphadenectomy alone might be an insufficient surgical procedure for endometrial cancer in patients at risk of lymph node metastasis,” the authors wrote. “The results also suggest that adjuvant chemotherapy could further improve survival of patients at high risk of lymph node metastasis.” “Combined pelvic and para-aortic lymphadenectomy is recommended as treatment for patients with endometrial carcinoma of intermediate or high risk of recurrence,” the authors concluded. “If a prospective randomised or comparative cohort study is planned to validate the therapeutic effect of lymphadenectomy, it should include both pelvic and para-aortic lymphadenectomy in patients of intermediate or high-risk of recurrence.” In an accompanying comment, Sean C Dowdy, MD, and Andrea Mariani, MD, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, agree with the authors that the SEPAL results now need validating with a randomised controlled trial. “Such a trial should also examine differences in morbidity, cost, and quality of life, all of which previous studies have failed to address,” they said. “Disease-specific survival is but one of many important endpoints because patients will often succumb to other comorbidities. Only by consideration of such factors will a standard of care be identified for the surgical treatment of endometrial cancer. Such a standard is long overdue.” SOURCE: The Lancet
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