ReviewEndometrial cancer—Revisiting the importance of pelvic and para aortic lymph nodes
Section snippets
Unstaged “high-risk” disease and routine adjuvant pelvic irradiation
The apparent “high-risk” group [3], [17] constitutes 25% of the early population; extra uterine disease is predicted in 25% of them (i.e., 6 patients of 100 presenting). Half of those with extra uterine disease will have extra nodal sites of disease including those with cytology positive only [31]. If the high-risk group are not staged (Fig. 1), routine adjuvant external beam pelvic irradiation is usual practice. Two relevant randomized studies provide an understanding of outcomes; the first by
Staging only the high risk
The relatively negative consequences of following algorithm 1 (Fig. 1) have led many [33], [34] to consider an alternate treatment algorithm (Fig. 3). In this algorithm, only patients having “high-risk” clinical stage I disease by virtue of grade and myometrial depth would have surgical staging. Of the 25 patients surgically staged, 17 would have no evidence of extra uterine disease although a few would have stage IIB disease. Many would argue that the 17 can be spared “unnecessary” irradiation
“High-risk” summary
Surgical staging may be justified in the clinically high-risk patients since 11 patients in 100 would be spared unnecessary pelvic irradiation and 5 in 100 will have extra pelvic uterine disease detected for which different treatments may be recommended. It would appear at the present time that patients with grade III outer half disease whose nodal status is unknown may benefit from pelvic irradiation (possibly external beam plus vault brachytherapy) if not subjected to a further staging
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2017, Revista Espanola de Medicina Nuclear e Imagen MolecularCitation Excerpt :The SENTI-ENDO multicentric trial concluded that SLN biopsy alone is recommended for low-risk and intermediate-risk endometrial cancer.31 Although this procedure is gaining acceptance, its methodology is not yet standardized and is still debated, especially when concerning the route of tracer administration (myometrium, subserosa, cervical, etc.).32–35 Different from endometrial cancer, the SLN procedure is better standardized in cervical cancer with as principal indications the IA2-IB1 stages.
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