SPLA for endometrial cancer: No benefit
Endometrial cancer is the most common gynaecological cancer in western Europe and North America. Standard treatment for stage 1 disease is hysterectomy and bilateral salpingo-oophorectomy, often with adjuvent radiotherapy. Systematic pelvic lymphadenectomy (SPLA) is sometimes done as a diagnostic and therapeutic procedure, but evidence of its efficacy is equivocal. Now a study at 85 centres in the United Kingdom, South Africa, Poland and New Zealand has shown no benefit from SPLA in early endometrial cancer.
A total of 1,408 women with stage 1 endometrial cancer were randomized to standard surgery with or without SPLA. Women at intermediate or high risk of recurrence were also randomized in a radiotherapy trial. After an average follow-up of 37 months, mortality was 88/704 without SPLA and 103/704 with SPLA, a non-significant increase of 16% in the SPLA group. The absolute difference in 5-year survival was 1%. Death or recurrence occurred in 107 versus 144 women, a significant 35% difference in favour of standard surgery without SPLA. After statistical adjustment, there were nonsignificant differences of 4% in overall survival and 25% in occurrence-free survival, both in favour of standard surgery without SPLA.
Systematic pelvic lymphadenectomy was not beneficial for women with early endometrial cancer.
The writing committee on behalf of the ASTEC study group. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009;373:125–136; Höckel M, Dornhöfer N. Treatment of early endometrial carcinoma: is less more? Ibid:97–99 (comment).