Studies suggest lymph removal, external beam radiation no help against early disease
FRIDAY, Dec. 12 (HealthDay News) -- Removal of the pelvic lymph nodes, as well as external beam radiation, should not be part of routine care for women with early endometrial cancer, two new studies show.
One study looked at removal of pelvic lymph nodes (pelvic lymphadenectomy), in addition to the standard treatments of hysterectomy and removal of both ovaries and both fallopian tubes (bilateral salpingo-oophorectomy -- BSO). Removal of pelvic lymph nodes is used to determine whether or not the cancer is present outside the uterus and as a therapeutic procedure.
This study included more than 1,400 women at 85 centers in four countries. The women, whose cancer was believed to be localized, were divided into two groups -- 704 underwent standard surgery (hysterectomy and BSO, peritoneal washing, and palpitation of para-aortic nodes), while the other 704 had standard surgery plus pelvic lymphadenectomy.
After a median follow-up of about three years, 88 women in the standard surgery group had died, compared with 103 in the pelvic lymphadenectomy group, which translates into a 16 percent greater risk of death. When the researchers looked at the combined chances of death or recurrent cancer, 107 women in the standard surgery group experienced one or the other, compared with 144 in the lymphadenectomy group, which translates into a 35 percent increased risk.
"This randomized trial has shown no evidence of a benefit for systematic lymphadenectomy for endometrial cancer in terms of overall, disease-specific, and recurrence-free survival. This study is one of the largest reported surgical gynecological cancer trials... Pelvic lymphadenectomy cannot be recommended as routine procedure for therapeutic purposes outside of clinical trials," concluded Dr. Ann Marie Swart, of the Medical Research Trials Unit in London, and colleagues.
The second study evaluated the effects of external beam radiotherapy (EBR). This therapy is typically offered to women who've had successful surgery for early endometrial cancer but are at increased risk of cancer recurrence.
The study included 905 women randomly selected to observation (453) or EBR (452) after surgery. EBR was delivered in 20 to 25 daily fractions up to the target dose.
After a median of 58 months follow-up, 68 women in the observation group and 67 in EBR group had died. Overall five-year survival was 84 percent in both groups.
The study found "no evidence of a benefit for external beam radiotherapy for early endometrial cancer at intermediate or high risk of recurrence, in terms of overall, disease-specific, and disease-specific recurrence-free survival. Combining these findings with data from other trials, we can exclude even a very small benefit of radiotherapy on overall survival."
The authors add that, "adjuvant external beam radiotherapy cannot be recommended as part of routine treatment to improve survival for women with early endometrial cancer at intermediate or high risk of recurrence, and brachytherapy [placement of small radioactive pellets near cancer site] might be preferred for local control."
The studies appear online and in an upcoming print issue of The Lancet.
The U.S. National Cancer Institute has more about treatment for endometrial cancer.
-- Robert Preidt
SOURCE: The Lancet, news release, Dec. 13, 2008
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