Isolated Tumor Cells and Routine Adjuvant Chemotherapy in Endometrial Cancer

Patients with endometrial cancer who have isolated tumor cells (ITCs) identified by sentinel lymph node (SLN) mapping should not routinely receive adjuvant chemotherapy, according to a study presented at the 48^th Annual Meeting of the Society of Gynecologic Oncology.¹

For the single-center study, researchers analyzed prospectively collected data from 519 patients who underwent hysterectomy, salpingo-oophorectomy, lymphadenectomy, and SLN mapping for endometrial cancer between November 2010 and December 2015. Of those, 85 patients had SLN metastases, including 51% with macrometastasis, 13% with micrometastasis, and 36% with ITCs.

Among the 31 patients with ITCs, 10 had stage IA, 15 had stage IB, 4 had stage II, and 1 had stage IIIA and IV disease. Ninety percent were endometrioid tumors, 77% were grade 1 or 2, and 68% of patients with ITCs had lymphovascular space invasion.

Investigators found that 35% of patients with ITCs received adjuvant chemotherapy and 45% underwent pelvic radiotherapy. Nearly a third received either vault brachytherapy only or no adjuvant treatment whatsoever.

Only 1 patient with ITCs had disease recurrence despite receiving adjuvant chemotherapy and radiotherapy.

No patients with ITCs and endometrioid histology recurred, suggesting that clinicians should tailor adjuvant treatment to uterine factors and histology and not base decisions solely on the presence of ITCs.

At 24 months, 93.8% of patients overall with ITCs were progression-free, including 100% of those treated with brachytherapy or observation alone and 91.7% for those who underwent external radiation and/or chemotherapy.

The findings suggest that patients with endometrial cancer who have ITCs identified by SLN mapping have excellent outcomes and should not routinely receive chemotherapy in the adjuvant setting.

Reference

1. Plante M, Stanleigh J, Renaud MC, Sebastianelli A, Gregoire J. Isolated tumor cells (ITC) identified by sentinel lymph node (SLN) mapping in endometrial cancer: Does adjuvant treatment matter? Paper presented at: 48^th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.