Advertisement

Role of the Appropriateness of the Pelvic Lymphadenectomy and Adjuvant Radiation Therapy in Early-Stage Poorly Differentiated Endometrial Carcinoma

  • Valerio Nardone
  • Paolo Tini
  • Luisa Marciello
  • Giuseppe Battaglia
  • Pierpaolo Pastina
  • Monica Crociani
  • Chiara Cancemi
  • Marta Vannini
  • Lucio Sebaste
  • Luigi Pirtoli
Original Article
  • 13 Downloads

Abstract

Purpose

With this work, we intend to investigate the prognostic role of the pelvic lymphadenectomy, analyzing the pattern of recurrence in poorly differentiated endometrial carcinoma.

Methods and Materials

Our study analyzes a total of 98 patients affected by early-stage (T1/T2) poorly differentiated endometrial carcinoma. Detailed data concerning clinical presentation, pathology, adjuvant treatment, and outcomes were collected and correlated with disease-free survival (DFS), further distinguished in local and distant DFS, and overall survival (OS). The extent of the lymphadenectomy was considered appropriated when a number of 12 lymph nodes were removed.

Results

The only characteristic significantly associated with locoregional DFS was the use of adjuvant radiation therapy (p: 0.003), whereas the use of adjuvant radiation therapy (RT, p: 0.004), the appropriateness of lymphadenectomy (p: 0.019), and the higher age (> 65 years, p: 0.037) are associated with distance DFS. The only significant variable associated with OS was the higher age (p: 0.025). On multivariate analysis, RT was correlated (p: 0.017) with locoregional DFS, whereas RT (p: 0.019) and age (p: 0.048) were correlated with distance DFS. The multivariate analysis of OS showed that the only parameter associated was the age (p: 0.047).

Conclusions

The results of our study underline the importance of an appropriate lymphadenectomy and the selection of the correct adjuvant strategy in the treatment of early-stage poorly differentiated endometrial carcinoma.

Keywords

Poorly differentiated endometrial carcinoma Lymphadenectomy Radiation therapy Chemotherapy Gynecology oncology 

Abbreviations

EC

Endometrial cancer

T

Extension of primary tumor

N

Lymph nodal status

RT

Radiation therapy

CHT

Chemotherapy

DFS

Disease-free survival

OS

Overall survival

Notes

Compliance with Ethical Standards

Conflict of interest

All the authors declare no conflicts of interest.

References

  1. 1.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.  https://doi.org/10.3322/caac.21208.CrossRefPubMedGoogle Scholar
  2. 2.
    Seamon LG, Fowler JM, Cohn DE. Lymphadenectomy for endometrial cancer: the controversy. Gynecol Oncol. 2010;117(1):6–8.  https://doi.org/10.1016/j.ygyno.2009.12.025.CrossRefPubMedGoogle Scholar
  3. 3.
    Creasman WT, Mutch DE, Herzog TJ. ASTEC lymphadenectomy and radiation therapy studies: are conclusions valid? Gynecol Oncol. 2010;116(3):293–4.  https://doi.org/10.1016/j.ygyno.2009.10.065.CrossRefPubMedGoogle Scholar
  4. 4.
    Uccella S, Podratz KC, Aletti GD, Mariani A. Lymphadenectomy in endometrial cancer. Lancet. 2009;373(9670):1170.  https://doi.org/10.1016/s0140-6736(09)60677-2.CrossRefPubMedGoogle Scholar
  5. 5.
    Uccella S, Podratz KC, Aletti GD, Mariani A. Re: systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2009;101(12):897–8.  https://doi.org/10.1093/jnci/djp124.CrossRefPubMedGoogle Scholar
  6. 6.
    Soliman PT, Frumovitz M, Spannuth W, Greer MJ, Sharma S, Schmeler KM, Ramirez PT, Levenback CF, Ramondetta LM. Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol. 2010;119(2):291–4.  https://doi.org/10.1016/j.ygyno.2010.07.011.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kumar S, Mariani A, Bakkum-Gamez JN, Weaver AL, McGree ME, Keeney GL, Cliby WA, Podratz KC, Dowdy SC. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013;130(3):441–5.  https://doi.org/10.1016/j.ygyno.2013.05.035.CrossRefPubMedGoogle Scholar
  8. 8.
    Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373(9658):125–36.  https://doi.org/10.1016/S0140-6736(08)61766-3.CrossRefPubMedGoogle Scholar
  9. 9.
    Panici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Croce C, Mangioni C. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.  https://doi.org/10.1093/jnci/djn397.CrossRefGoogle Scholar
  10. 10.
    Havrilesky LJ, Cragun JM, Calingaert B, Synan I, Secord AA, Soper JT, Clarke-Pearson DL, Berchuck A. Resection of lymph node metastases influences survival in stage IIIC endometrial cancer. Gynecol Oncol. 2005;99(3):689–95.  https://doi.org/10.1016/j.ygyno.2005.07.014.CrossRefPubMedGoogle Scholar
  11. 11.
    Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010;375(9721):1165–72.  https://doi.org/10.1016/S0140-6736(09)62002-X.CrossRefPubMedGoogle Scholar
  12. 12.
    Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, Clarke-Pearson DL, Soper JT. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol. 2006;102(1):92–7.  https://doi.org/10.1016/j.ygyno.2005.11.032.CrossRefPubMedGoogle Scholar
  13. 13.
    Abu-Rustum NR, Iasonos A, Zhou Q, Oke E, Soslow RA, Alektiar KM, Chi DS, Barakat RR. Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma? Am J Obstet Gynecol. 2008;198(4):457-e1.  https://doi.org/10.1016/j.ajog.2008.01.010 (discussion 457 e455–e456).CrossRefGoogle Scholar
  14. 14.
    Berek JS, Hacker NF. Berek and Hacker’s gynecologic oncology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2010.Google Scholar
  15. 15.
    Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Sharma C, Deutsch I, Lewin SN, Burke WM, Qiao Y, Sun X, Chao CK, Herzog TJ, Wright JD. Lymphadenectomy influences the utilization of adjuvant radiation treatment for endometrial cancer. Am J Obstet Gynecol. 2011;205(6):562.  https://doi.org/10.1016/j.ajog.2011.09.001.CrossRefPubMedGoogle Scholar
  17. 17.
    Frumovitz M, Singh DK, Meyer L, Smith DH, Wertheim I, Resnik E, Bodurka DC. Predictors of final histology in patients with endometrial cancer. Gynecol Oncol. 2004;95(3):463–8.  https://doi.org/10.1016/j.ygyno.2004.07.016.CrossRefPubMedGoogle Scholar
  18. 18.
    Ben-Shachar I, Pavelka J, Cohn DE, Copeland LJ, Ramirez N, Manolitsas T, Fowler JM. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol. 2005;105(3):487–93.  https://doi.org/10.1097/01.AOG.0000149151.74863.c4.CrossRefPubMedGoogle Scholar
  19. 19.
    Kwon JS, Francis JA, Qiu F, Weir MM, Ettler HC. When is a pathology review indicated in endometrial cancer? Obstet Gynecol. 2007;110(6):1224–30.  https://doi.org/10.1097/01.AOG.0000287618.86078.6c.CrossRefPubMedGoogle Scholar
  20. 20.
    Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H. Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging—a meta-analysis and Bayesian analysis. Radiology. 2000;216(2):444–9.  https://doi.org/10.1148/radiology.216.2.r00au17444.CrossRefPubMedGoogle Scholar
  21. 21.
    Franchi M, Ghezzi F, Melpignano M, Cherchi PL, Scarabelli C, Apolloni C, Zanaboni F. Clinical value of intraoperative gross examination in endometrial cancer. Gynecol Oncol. 2000;76(3):357–61.  https://doi.org/10.1006/gyno.1999.5694.CrossRefPubMedGoogle Scholar
  22. 22.
    Kucera E, Kainz C, Reinthaller A, Sliutz G, Leodolter S, Kucera H, Breitenecker G. Accuracy of intraoperative frozen-section diagnosis in stage I endometrial adenocarcinoma. Gynecol Obstet Invest. 2000;49(1):62–6.  https://doi.org/10.1159/000010215.CrossRefPubMedGoogle Scholar
  23. 23.
    Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, Podratz KC. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11–8.  https://doi.org/10.1016/j.ygyno.2008.01.023.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Baxter NN. Is lymph node count an ideal quality indicator for cancer care? J Surg Oncol. 2009;99(4):265–8.  https://doi.org/10.1002/jso.21197.CrossRefPubMedGoogle Scholar
  25. 25.
    Hampl M, Hantschmann P, Michels W, Hillemanns P, German Multicenter Study Group. Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: results of a multicenter study in Germany. Gynecol Oncol. 2008;111(2):282–8.  https://doi.org/10.1016/j.ygyno.2008.08.007.CrossRefPubMedGoogle Scholar
  26. 26.
    Hauspy J, Beiner M, Harley I, Ehrlich L, Rasty G, Covens A. Sentinel lymph node in vulvar cancer. Cancer. 2007;110(5):1015–23.  https://doi.org/10.1002/cncr.22874.CrossRefPubMedGoogle Scholar
  27. 27.
    Rob L, Strnad P, Robova H, Charvat M, Pluta M, Schlegerova D, Hrehorcak M. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol. 2005;98(2):281–8.  https://doi.org/10.1016/j.ygyno.2005.04.016.CrossRefPubMedGoogle Scholar
  28. 28.
    Frumovitz M, Ramirez PT, Levenback CF. Lymphatic mapping and sentinel lymph node detection in women with cervical cancer. Gynecol Oncol. 2008;110(3 Suppl 2):S17–20.  https://doi.org/10.1016/j.ygyno.2008.03.012.CrossRefPubMedGoogle Scholar
  29. 29.
    Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, Levine DA, Brown CL, Chi DS, Barakat RR, Gemignani ML. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113(2):163–9.  https://doi.org/10.1016/j.ygyno.2009.01.003.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ballester M, Dubernard G, Rouzier R, Barranger E, Darai E. Use of the sentinel node procedure to stage endometrial cancer. Ann Surg Oncol. 2008;15(5):1523–9.  https://doi.org/10.1245/s10434-008-9841-1.CrossRefPubMedGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2018

Authors and Affiliations

  • Valerio Nardone
    • 1
  • Paolo Tini
    • 1
  • Luisa Marciello
    • 2
  • Giuseppe Battaglia
    • 1
  • Pierpaolo Pastina
    • 1
  • Monica Crociani
    • 1
  • Chiara Cancemi
    • 1
  • Marta Vannini
    • 1
  • Lucio Sebaste
    • 1
  • Luigi Pirtoli
    • 1
  1. 1.Unit of Radiation OncologyUniversity Hospital of SienaSienaItaly
  2. 2.Unit of Radiation OncologyHospital of PratoPratoItaly

Personalised recommendations