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Full Staging of Endometrial Cancer Reduces Unnecessary Radiotherapy and Need for Further Surgery: Presented at ASCO

By Bruce K. Dixon

CHICAGO, IL -- June 4, 2003 -- Examining the lymph nodes in all women with endometrial cancer can reduce the use of radiotherapy and the risk of radiation injury for patients -- saving both lives and dollars, according to a recommendation delivered June 2^nd here at the 39^th Annual Meeting of the American Society of Clinical Oncology.

"Full staging should be considered for all patients with endometrial cancer," noted Matthew Powell, MD, assistant professor of obstetrics and gynaecology at Washington University School of Medicine, in St. Louis, Missouri.

Dr. Powell presented data showing that less than half of patients with endometrial cancer undergo lymph-node dissection.

"Endometrial cancer is a surgically staged disease, and part of that staging process is assessing the lymph nodes," he said. "Many physicians believe early-stage endometrial cancer is readily curable just by removing the uterus and, therefore, do not fully stage these earliest of lesions. This omission often necessitates additional surgery to assess lymph nodes."

Dr. Powell led a retrospective study of 144 women with grade I, apparent stage I endometrial cancer. The average age of the patients was 62. Lymph nodes were removed from 71% of the cohort. Six patients had major complications, and 3 were surgically staged. The median length of stay was 4 days. Final-stage distribution in patients who were surgically staged was 31-IA, 34-IB, 15-IC, 4-IIA, 1-IIB, 6-IIIA, and 12-IIIC. The grade was changed in 12% of cases, including 2 patients found to have grade III tumours.

Adjuvant radiation would have been recommended for 40 patients based upon uterine pathology alone, had staging not been performed, the authors noted. With comprehensive surgical staging, however, only 18 patients would have required radiation. These treatment recommendations were significantly different, with a P value of less than 0.0008. Thus, 22 patients would have avoided radiation and an additional 5 would have required less intense therapy.

The lymph-node examination also identified 3 women with disease that was more advanced than would have been suspected, because they had no identifiable risk factors; their final pathology in the uterus did not show any significant tumour, but they had positive lymph nodes. "So one would guess that those patients would have likely died from their disease. All 3 are alive and well after appropriate therapy," said Dr. Powell.

This study was not designed to estimate survival, although Dr. Powell speculates that abdominal lymph-node removal in all patients with endometrial cancer will save lives in addition to reducing health-care costs ($28 million annually in the U.S. alone).

"The perioperative morbidity is the same, and [one] detects more patients with metastatic disease and also spares people unnecessary radiation, which I think is the biggest benefit. So many people end up being re-operated on for radiation injury, and that isn't even factored into this cost analysis," he said.

Endometrial cancer is the most common gynaecological cancer in the U.S., with 40,000 new cases annually. About half of the women diagnosed have grade I disease.


[Study title: Staging Grade 1 Endometrial Cancers: Saving Dollars and Lives. Abstract 1835]

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