"There is no evidence that lymphadenectomy improves overall survival or disease-specific survival," said Henry Kitchener, MD, professor of gynaecological surgery, St. Mary's Hospital, Manchester, United Kingdom. If anything, he said, there was a trend toward shorter recurrence-free survival among women who underwent lymphadenectomy, Dr. Kitchener said.

Dr. Kitchener reported early results from the Randomized Trial of Lymphadenectomy and of Adjuvant External Beam Radiotherapy in the Treatment of Endometrial Cancer (ASTEC). The trial was designed to assess the effect of lymphadenectomy and adjuvant external beam radiation therapy in the treatment of endometrial cancer.

The study randomized patients to conventional surgery or conventional surgery plus lymphadenectomy, which consisted of dissection of the iliac and obturator nodes. All patients were then further randomized to undergo brachytherapy with or without external beam radiation. Dr. Kitchener said the radiation data are still under analysis.

The study recruited 1,408 women between 1998 and 2005, with a final enrollment of 673 in the lymphadenectomy group and 700 in the conventional-surgery group. The median age was 63 years, and patients were randomized a median of 26 days after diagnosis. Eighty-two percent of the patients in each group had a tumor at International Federation of Gynecology and Obstetrics (FIGO) stage 1A-C. Thirty-nine percent of the patients in both arms went on to have external beam radiotherapy.

Of the women in the lymphadenectomy group, 62 patients did not actually undergo the procedure due to poor visibility or other problems. Of the 611 who had lymphadenectomy, 54 (9%) had at least one positive node. Similarly, 32 of 700 women in the conventional surgery group did undergo lymphadenectomy. Of those patients, 9 (28%) had some nodal involvement.

Three-year survival was 87% among patients who did not undergo lymphadenectomy, and 86% among those who did. Disease-free survival was 84% and 81%, respectively. A total of 171 patients have died, including 124 from endometrial cancer or treatment-related causes, and 47 from other causes. There have been a total of 235 recurrences or deaths from all causes. There were no differences in overall survival on intention-to-treat analysis.

These findings suggest that surgical staging alone may not be enough to make a difference in survival, Dr. Kitchener said.


[Presentation title: ASTEC – A Study in the Treatment of Endometrial Cancer: A Randomised Trial of Lymphadenectomy in the Treatment of Endometrial Cancer. Abstract 45]

Copyright © 2009 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content.