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new research: supports having para-aortic lymph nodes removed for biopsies in high-grade endometrial cancer hysterectomies

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

Survival Effect of Para-aortic Lymphadenectomy in Endometrial Cancer (SEPAL study): A Retrospective Cohort Analysis
Lancet. 2010 Apr 3;375(9721):1165-1172, Y Todo, H Kato, M Kaneuchi, H Watari, M Takeda, N Sakuragi

ABSTRACT
The results of this large retrospective analysis conducted in 2 Japanese centers suggest significantly improved outcomes with para-aortic and pelvic lymphadenectomy (versus pelvic lymphadenectomy alone)...

Background: In response to findings that pelvic lymphadenectomy does not have any therapeutic benefit for endometrial cancer, we 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.

Methods: We selected 671 patients with endometrial carcinoma who had been treated with complete, systematic pelvic lymphadenectomy (n=325 patients) or combined pelvic and para-aortic lymphadenectomy (n=346) at two 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.

Findings: Overall survival was significantly longer in the pelvic and para-aortic lymphadenectomy group than in the pelvic lymphadenectomy group (HR 0.53, 95% CI 0.38–0.76; p=0.0005). This association was also recorded in 407 patients at intermediate or high risk (p=0.0009), but overall survival was not related to lymphadenectomy type in low-risk patients. Multivariate analysis of prognostic factors showed that in patients with intermediate or high risk of recurrence, pelvic and para-aortic lymphadenectomy reduced the risk of death compared with pelvic lymphadenectomy (0.44, 0.30–0.64; p<0.0001). Analysis of 328 patients with intermediate or high risk who were treated with adjuvant radiotherapy or chemotherapy showed that patient survival improved with pelvic and para-aortic lymphadenectomy (0.48, 0.29–0.83; p=0.0049) and with adjuvant chemotherapy (0.59, 0.37–1.00; p=0•0465) independently of one another.

Interpretation: Combined pelvic and para-aortic lymphadenectomy is recommended as treatment for patients with endometrial carcinoma of intermediate or high risk of recurrence. 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.

Funding: Japanese Foundation for Multidisciplinary Treatment of Cancer, and the Japan Society for the Promotion of Science.

cleo
Posts: 145
Joined: Sep 2009

I read this with interest as I have Grade 4 carcinosarcoma and para-aortic lymph glands were removed during the surgery in August 2007. I had radiotherapy only after surgery and have just had another unchanged scan. My oncologist has not mentioned the word 'remission' but I see him tomorrow so will that be the day?! I don't know that I think that you can be in remission really...I just know that I intend to continiue being well. I did have a concern that by not having chemotherapy something had been missed but the above has eased my mind.
Have great admiration for you incidently.

Rribbit
Posts: 9
Joined: Apr 2009

Is this same survival benefit found if pelvic/para-aortic nodes are removed after initial surgery and chemotherapy? Or is it only therapeutic if done at time of initial staging?

My cancer was discovered to have spread to 1 pelvic, 1 para-aortic and 1 porta hepatis node AFTER my initial hysterectomy was complete. (no one knew I had cancer until the pathology from the hysterectomy came back a week later) I have requested to have my nodes removed now to help prevent recurrence, but my Dr. has said no, it won't help. Is this true?

So far, my cancer has been contained to only those 3 nodes. 2 went away with chemo and 1 was just removed surgically.

Thoughts?

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

I had a para-aortic lymph node light up on a PET scan, but it was in too dangerous a spot to even do a needle biopsy, let alone cut it out. The very name "para-aortic" means "near an aorta", I think, and removal of ALL para-aortic lymph nodes would be very delicate and dangerous surgery. I had a handful of para-aortic nodes removed during my hysterectomy, a few from each side, but not all of them. Overall I had 25 pelvic and para-aortic lymph nodes removed during my hysterectomy, and I do have some mild lympohodema in both ankles because of that (compounded by radiating the remaining pelvic nodes!) So, I can understand your oncologist's reluctance to operate to remove your nodes, as the lymph system plays an important role in the body's immune system and lymphodema isn't curable. Especially when the chemo seems to be working at knocking back any cancer in your lymph nodes.

A side note: my next CT/PET 3 months and 10 rounds of weekly taxol later, none of my lymph nodes lit up as cancerous in the scan. Hard to know what to do, isn't it?

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

Hi all,

I have been offline for awhile - stressed out, waiting for tests, and then results. I got my PET/CT approved by miraculous response to my doc's appeal after initial denial by Aetna. My battle last year was long and futile but a lump in my neck and rising CA125 looked like recurrence so they must have had a heart!!

Anyway, my doc thinks its "strong liklihood of cancer in my left subclavian node - an area that lit up last year but they thought it was brown fat. I am awaiting surgery to have it removed. Please pray for me ladies.

I find this article interesting. It's the first time I checked in here in many weeks. Thanks again, Linda.

Mary Ann

Ro10's picture
Ro10
Posts: 1579
Joined: Jan 2009

I hope that the lump in your neck is something other than cancer. I can understand you feeling stressed out. I never heard of Brown Fat before. I will keep you in my prayers. When will you have the node removed. I hope that when they remove the node, that takes care of the cancer, too. Hope you are doing your guided imagery to help take your mind off of your worries. In peace and caring.

kkstef's picture
kkstef
Posts: 706
Joined: May 2008

Mary Ann...I was wondering where you were as I hadn't seen any posts from you for some time. I always think of you as the voice of calm and reason. You are a very tough person and I know that whatever the outcome of your surgery you will fight this with all of your might! Just know that you are in my prayers and thoughts. Please keep us posted!

HUGS....Karen

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