Introduction/Background In 2020 ESGO/ESTRO/ESP guidelines sentinel lymph node biopsy (SLNB) has been introduced as an alternative to lymph node dissection (LND). A negative SLN is accepted to confirm pN0, has prognostic significance but evenly should increase staged patients and modulate adjuvant treatment.
We aimed to assess the role of nodal staging in the management of adjuvant treatment in a consecutive series of HIR and HR EC.
Methodology In a ‘real life’ study 172 consecutive patients had a postoperative diagnosis of HIR (68 patients) and HR (104 patients) endometrial cancer (EC) between Dec 2016 and Dec 2022. Risk class was re-classified according to the most recent 2020 ESGO guidelines and adjuvant treatment was reported as effectively administered to the patient (ESGO Grade of recommendation is specified: Grade A,B,C).
Results Overall, 68 patients at HIR and 104 HR had lymph nodes assessed in 106 cases (61.6%: respectively 51.4% in HIR and 68.2% in HR). This was achieved by SLNB in 22.6% and LND in 77.3%. After multidisciplinary tumor board decision and patient consent HIR-pN0 were treated 19(55.8%) with BT/EBRT (Grade B); 9(26.4%) with sequential CRT±BT (Grade C). Six (18.7%) patients were not treated due to co-morbidities or patient refusal (Grade C).
Patients cN0pNX received respectively 19(57.5%) EBRT/BT (Grade A/B), 8(24.2%) sequential CRT±BT, (Grade B), and 6 (18.1%) no treatment. Among the HR: only 6 patients (5.7%) were defined as ‘High risk’ due to pN+. HR patients were treated 63 (60.5%) with sequential CRT±BT (Grade A/B), 18(17.3%) with BT/EBRT and 23(22.1%) were not treated due to co-morbidities or patient refusal.
Conclusion HIR patients received adjuvant CRT±BT in about 25% of cases (Grade C) independently from nodal staging: cost-effectiveness data are needed to accurately modulate adjuvant treatment. About 39% of HR patients were undertreated due to low-performance status/co-morbidities.
Disclosures The authors declare they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. No specific funding was obtained for this study.
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