Patients' and gynecologists' views on sentinel lymph node mapping in low- and intermediate-risk endometrial cancer: a Dutch vignette study

2020 ◽  
Vol 30 (6) ◽  
pp. 813-818
Author(s):  
Johanna W M Aarts ◽  
Lara C Burg ◽  
Jenneke C Kasius ◽  
Hans Groenewoud ◽  
Arjan A Kraayenbrink ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Travel Time ◽  
Adjuvant Radiotherapy ◽  
Gynecologic Oncology ◽  
Intermediate Risk ◽  
Survival Gain ◽  
Vignette Study ◽  
Increased Risk

ObjectiveSentinel lymph node (SLN) mapping in endometrial cancer is gaining ground. However, patient views on this new technique are unknown. The aim of this study was to determine factors important to patients and gynecologists when considering SLN mapping in low- and intermediate-risk endometrial cancer.MethodsWe performed a vignette study. Patients who underwent a total hysterectomy for low- or intermediate-risk endometrial cancer between 2012 and 2015 were invited. Dutch gynecologists specializing in gynecologic oncology were also invited. We based the selection for attributes in the vignettes on literature and interviews: risk of complications of SLN mapping; chance of finding a metastasis; survival gain; risk of complications after radiotherapy; operation time; and hospital of surgery (travel time). We developed a questionnaire with 18 hypothetical scenarios. Each attribute level varied and for each scenario, participants were asked how strongly they would prefer SLN on a scale from 1 to 7. The strength of preference for each scenario was analyzed using linear mixed effects models.ResultsA total of 38% of patients (41/108) and 33% of gynecologists (42/126) participated in the study. Overall, they had a preference for SLN. The mean preference for patients was 4.29 (95% CI 3.72 to 4.85) and 4.39 (95% CI 3.99 to 4.78) for gynecologists. Patients’ preferences increased from 3.4 in the case of no survival gain to 4.9 in the case of 3-year survival gain (P<0.05) and it decreased when travel time increased to >60 min (−0.4, P=0.024), or with an increased risk of complications after adjuvant radiotherapy (−0.6, P=0.002). For gynecologists all attributes except travel time were important.ConclusionsOverall, patients and gynecologists were in favor of SLN mapping in low- and intermediate-risk endometrial cancer. Most important to patients were survival gain, travel time, and complication risk after adjuvant radiotherapy. These preferences should be taken into account when counseling about SLN mapping.

scholarly journals Factors influencing the adoption of the sentinel lymph node technique for endometrial cancer staging: an international survey of gynecologic oncologists

2019 ◽  
Vol 29 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Jvan Casarin ◽  
Francesco Multinu ◽  
Nadeem Abu-Rustum ◽  
David Cibula ◽  
William A Cliby ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Sentinel Lymph Node ◽  
Tumor Cells ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Cancer Staging ◽  
Isolated Tumor Cells ◽  
Factors Influencing

ObjectiveTo explore the factors influencing adoption of the sentinel lymph node (SLN) technique for endometrial cancer staging among gynecologic oncologists.MethodsA self-administered, web-based survey was sent via email (April 20 through May 21, 2017) to all members of European Society of Gynecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncologists. Surgical and pathologic practices related to SLN and reasons for not adopting this technique were investigated.ResultsOverall, 489 attending physicians or consultants in gynecologic oncology from 69 countries responded: 201 (41.1%), 118 (24.1%), and 117 (23.9%) from Europe, the USA, and other countries, respectively (10.8% did not report a country). SLN was adopted by 246 (50.3%) respondents, with 93.1% injecting the cervix and 62.6 % using indocyanine green dye. The National Comprehensive Cancer Network SLN algorithm was followed by 160 (65.0%) respondents (USA 74.4%, Europe 55.4%, other countries 71.4%). However, 66.7% completed a backup lymphadenectomy in high-risk patients. When SLN biopsy revealed isolated tumor cells, 13.8% of respondents recommended adjuvant therapy. This percentage increased to 52% if micrometastases were detected. Among the 243 not adopting SLN, 50.2% cited lack of evidence and 45.3% stated that inadequate instrumentation fueled their decisions.ConclusionsSLN with a cervical injection is gaining widespread acceptance for staging of endometrial cancer among gynecologic oncologists worldwide. Standardization of the surgical approach with the National Comprehensive Care Network algorithm is applied by most users. Management of isolated tumor cells and the role of backup lymphadenectomy for ‘high-risk’ cases remain areas of investigation.

Factors Predictive of Receiving Adjuvant Radiotherapy in High-Intermediate–Risk Stage I Endometrial Cancer

2018 ◽  
Vol 28 (5) ◽  
pp. 882-889
Author(s):  
Mary McGunigal ◽  
Ariel Pollock ◽  
John T. Doucette ◽  
Jerry Liu ◽  
Manjeet Chadha ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Adjuvant Radiotherapy ◽  
National Cancer Data Base ◽  
External Beam ◽  
Intermediate Risk ◽  
Node Dissection ◽  
Related Factors ◽  
Cancer Data

ObjectivesRandomized trials have shown a local control benefit with adjuvant radiotherapy (RT) in high-intermediate–risk endometrial cancer patients, although not all such patients receive RT. We reviewed the National Cancer Data Base to investigate which patient/tumor-related factors are associated with delivery of adjuvant RT.MethodsThe National Cancer Data Base was queried for patients diagnosed with International Federation of Gynecology and Obstetrics 2009 stage I endometrioid adenocarcinoma from 1998 to 2012 who underwent surgery +/− adjuvant RT. Exclusion criteria were unknown stage/grade, nonsurgical primary therapy, less than 30 days’ follow-up, RT of more than 6 months after surgery, or palliative treatment. High-intermediate risk was defined based on Post Operative Radiation Therapy in Endometrial Carcinoma 2 criteria: older than 60 years with stage IA grade 3 or stage IB grade 1–2.ResultsSeventeen thousand five hundred twenty-four met inclusion criteria, and the 13,651 patients with complete data were subjected to a multiple logistic regression analysis; 7814 (57.2%) received surgery alone, and 5837 (42.8%) received surgery + RT. Receipt of adjuvant RT was more likely among black women and women with higher income, Northeastern residence, diagnosis after 2010, greater than 50% myometrial invasion, and receipt of adjuvant chemotherapy (P < 0.05). Patients older than 80 years or those undergoing lymph node dissection were less likely to receive adjuvant RT (P < 0.05). Of those treated with RT, 44.0% received external beam therapy, 54.8% received vaginal cuff brachytherapy, and 0.6% received both. Among irradiated women, patients older than 80 years and those with Northeastern residence, treatment at academic facilities, diagnosis after 2004, and lymph node dissection were more likely to undergo brachytherapy over external beam radiation therapy (P < 0.05). Overall use of adjuvant RT was 28.8% between 1998 and 2004, 42.0% between 2005 and 2010, and 43.4% between 2011 and 2012; the difference between 1998–2004 and 2005–2010 was not statistically significant.ConclusionsFewer than half of patients with high-intermediate–risk endometrial cancer by Post Operative Radiation Therapy in Endometrial Carcinoma 2 criteria received adjuvant RT despite evidence demonstrating improved local control. Both patient- and tumor-related factors are associated with delivery of adjuvant RT and the modality selected.

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