The role of lymphadenectomy in endometrial cancer: was the ASTEC trial doomed by design and are we destined to repeat that mistake?

Gynecologic Oncology
R Wendel Naumann

Abstract

This study examines the design of previous and future trials of lymph node dissection in endometrial cancer. Data from previous trials were used to construct a decision analysis modeling the risk of lymphatic spread and the effects of treatment on patients with endometrial cancer. This model was then applied to previous trials as well as other future trial designs that might be used to address this subject. Comparing the predicted and actual results in the ASTEC trial, the model closely mimics the survival results with and without lymph node dissection for the low and high risk groups. The model suggests a survival difference of less than 2% between the experimental and control arms of the ASTEC trial under all circumstances. Sensitivity analyses reveal that these conclusions are robust. Future trial designs were also modeled with hysterectomy only, hysterectomy with radiation in intermediate risk patients, and staging with radiation only with node positive patients. Predicted outcomes for these approaches yield survival rates of 88%, 90%, and 93% in clinical stage I patients who have a risk of pelvic node involvement of approximately 7%. These estimates were 78%, 82%, and 89% in intermediate risk patients who have a risk of no...Continue Reading

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Citations

May 7, 2014·Archives of Gynecology and Obstetrics·Rudy Leon De WildeAnja Herrmann
Dec 5, 2015·Annals of Oncology : Official Journal of the European Society for Medical Oncology·N ColomboUNKNOWN ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group
Dec 20, 2015·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Nicoletta ColomboUNKNOWN ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group
Dec 10, 2015·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·Nicoletta ColomboUNKNOWN ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group
Nov 6, 2013·Obstetrics and Gynecology International·Fabien Vidal, Arash Rafii
Dec 1, 2017·Journal of Gynecologic Oncology·Pluvio J CoronadoIgnacio Zapardiel
Sep 3, 2013·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·S JantarasaengaramK Vairojanavong
May 20, 2017·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·James CripeGina Mantia-Smaldone
May 19, 2018·World Journal of Surgical Oncology·Sarah BruggerMartin Pölcher
Jan 17, 2014·The Journal of Obstetrics and Gynaecology Research·Sokbom KangHidemichi Watari
May 3, 2014·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·L Valentin
Jan 9, 2020·International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society·Katherine I StewartPamela T Soliman
Nov 16, 2016·Indian Journal of Urology : IJU : Journal of the Urological Society of India·Susan F Slovin
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Aug 17, 2018·Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al]·S MarnitzJ Herter

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