The Evolving Role of Adjuvant Therapy in Endometrial Cancer

Crit Rev Oncol Hematol. 2011 May; 78(2):79-91; A Gadducci, C Greco

Abstract

Extra-fascial total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection is the initial treatment for endometrial cancer. Unresolved scientific controversy exists regarding the selection of patients who may benefit from lymphadenectomy, the magnitude of such benefit, and the role of adjuvant therapy. External pelvic irradiation has been shown to reduce loco-regional recurrences without improving survival. Meta-analyses of randomized trials indicate that external pelvic irradiation offers a significant benefit in terms of survival only in high-risk disease (i.e. stage Ic grade 3). Intermediate risk patients (i.e. stage Ib grade 3 disease), therefore, may be treated with adjuvant intravaginal brachytherapy alone to avoid the risk of side effects associated with pelvic irradiation. Overall, patients with clinically early endometrial cancer develop relapses in less than 20% of cases, mostly at distant sites.

Sentinel lymph node biopsy in the management of early-stage cervical carcinoma ☆

A prospective no-randomized clinical trial

John P. Diaz (a),1, Mary L. Gemignani (a), Neeta Pandit-Taskar (b), Kay J. Park (c), Melissa P. Murray (c=, Dennis S. Chi (a), Yukio Sonoda (a), Richard R. Barakat (a), Nadeem R. Abu-Rustum (a)

(a) Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, (b) Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, (c)-   Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Gynecologic Oncology 120 (2011) 347–352

Keywords: Sentinel lymph nodes, Micrometastasis, Cervical cancer

Objectives. We aimed to determine the sentinel lymph node detection rates, accuracy in predicting the status of lymph node metastasis, and if pathologic ultrastaging improves the detection of micrometastases and isolated tumor cells at the time of primary surgery for cervical cancer.

Methods. A prospective, non-randomized study of women with early-stage (FIGO stage IA1 with lymphovascular space involvement — IIA) cervical carcinoma was conducted from June 2003 to August 2009. All patients underwent an intraoperative intracervical blue dye injection. Patients who underwent a preoperative lymphoscintigraphy received a 99 m Tc sulfur colloid injection in addition. All patients underwent sentinel lymph node (SLN) identification followed by a complete pelvic node and parametrial dissection. SLN were evaluated using our institutional protocol that included pathologic ultrastaging.