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Is Sentinel Lymph Node Biopsy Alone Oncologically Safe for Patients With Early-Stage Cervical Cancer?


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In a study of patients with early-stage cervical cancer presented by Balaya et al during the Gynecologic Cancer Oral Abstract Session of the ASCO20 Virtual Scientific Program (Abstract 6006), researchers assessed disease-free and disease-specific survival to determine whether sentinel lymph node biopsy alone was a valid standard of care, or if bilateral pelvic lymphadenectomy—the current “gold standard” for lymph node staging in cervical cancer—was needed for these patients.

“Sentinel lymph node biopsy alone is oncologically safe in early-stage cervical cancer. Full lymphadenectomy could be omitted in case of bilateral negative sentinel lymph node biopsy. Worse prognosis was associated with higher FIGO stage disease.”
— Balaya et al

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Study Details

Researchers performed an analysis of two prospective, multicenter trials of sentinel lymph node biopsy for patients with cervical cancer (SENTICOL I and II). Patients from 30 centers in France with early-stage disease, negative sentinel lymph nodes after ultrastaging, and negative non–sentinel lymph nodes after final pathologic examination were included.

Between January 2005 and July 2012, 259 patients met the inclusion criteria: 85 patients underwent only bilateral sentinel lymph node biopsy, and 174 patients underwent bilateral pelvic lymphadenectomy. Between groups, there were no differences in histology, final FIGO stage, or surgical method. In the bilateral pelvic lymphadenectomy group, patients more frequently had tumors larger than 20 mm (22.9% vs 10.7%), and more had undergone postoperative radiochemotherapy (10.7% vs 1.6%).

Results

The median follow-up was 47 months. During the follow-up, 21 patients (8.1%) experienced recurrences, including four nodal recurrences (1.9%), and nine patients (3.5%) died of their disease.

The 5-year disease-free survival and disease-specific survival were similar between the two groups—94.1% for patients who had undergone sentinel lymph node biopsy vs 97.7% for those who had undergone bilateral pelvic lymphadenectomy, and 88.2% vs 93.7%, respectively. After controlling for final FIGO stage and margin status, sentinel lymph node biopsy compared to bilateral pelvic lymphadenectomy was not associated with disease-free and disease-specific survival. Only final FIGO stage was an independent predictor of disease-specific survival.

In their presentation, the authors pointed out that in this population—patients with early-stage cervical cancer—the most important prognostic factor is risk assessment by Sedlis criteria, and pointed out that survival equivalence needs to be confirmed in the future by further properly designed trials.

The authors concluded, “Sentinel lymph node biopsy alone is oncologically safe in early-stage cervical cancer. Full lymphadenectomy could be omitted in case of bilateral negative sentinel lymph node biopsy. Worse prognosis was associated with higher FIGO stage disease.”

Disclosure: For full disclosures of the study authors, visit coi.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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