Lymphadenectomy Does Not Improve Survival in Advanced Ovarian Cancer

Article

Systematic lymphadenectomy in patients with advanced ovarian cancer and complete resection does not improve progression-free or overall survival, and should be omitted, according to results of a new study.

[[{"type":"media","view_mode":"media_crop","fid":"60306","attributes":{"alt":"Philipp Harter, MD, PhD, presenting results of the study; photo © ASCO/Scott Morgan 2017","class":"media-image","id":"media_crop_8421697621752","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7613","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":"Philipp Harter, MD, PhD, presenting results of the study; photo © ASCO/Scott Morgan 2017","typeof":"foaf:Image"}}]]

Systematic lymphadenectomy (LNE) in patients with advanced ovarian cancer and complete resection does not improve progression-free or overall survival (OS), and should be omitted, according to results of a new study.

“Upfront surgery aiming at macroscopic complete resection is the goal in patients with primary advanced ovarian cancer,” said Philipp Harter, MD, PhD, of the Kliniken Essen-Mitte in Germany, during his presentation of the LION study (abstract 5500) at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting. Previous studies have showed mixed results regarding LNE in patients with otherwise complete resection.

The LION trial randomized 650 patients with advanced epithelial ovarian cancer and macroscopic complete resection to either systematic pelvic and para-aortic LNE (323 patients in intention-to-treat cohort), or no LNE (324 patients in intention-to-treat cohort). Patients were well matched between the groups, with a median age of 60 years, primarily ECOG 0 performance status, and mostly grade 2/3 serous histology.

Lymph node metastases were detected in 55.7% of the LNE patients. The median number of resected lymph nodes in those patients was 57 (22 para-aortic, 35 pelvic). The LNE patients had a median of 1 hour more of surgical duration (P < .001) and significantly more blood loss during surgery (P < .001). They also required more transfusions, experienced more infections requiring antibiotics (P = .03), and experienced a higher rate of 60-day postoperative mortality (3.1% vs 0.9%; P = .049).

These differences, however, did not translate into any difference with regard to survival outcomes. The full cohort had a median progression-free survival of 25.5 months, and a median OS of 67.2 months, with a 5-year OS rate of 55.9%. The median OS in LNE patients was 65.5 months, compared with 69.2 months with no LNE, yielding a hazard ratio of 1.057 (95% CI, 0.833–1.341). Similarly, the median progression-free survival in both groups was the same, at 25.5 months, for an HR of 1.106 (95% CI, 0.915–1.338).

A quality-of-life analysis using the QLQ-C30 Global Health Status instrument found nearly identical results in the two groups.

“Our data indicate that systematic LNE of clinical negative lymph nodes in patients with advanced ovarian cancer and complete resection should be omitted,” Harter concluded.

Ritu Salani, MD, MBA, of the Ohio State University Wexner Medical Center, was the Discussant for the session, and she agreed that these data suggest omitting LNE is acceptable. “I always thought that the lymph nodes represented a sanctuary for ovarian cancer and this is why we removed them, and I think this actually debunks that theory,” she said, adding that doing so would likely have cost-effectiveness benefits as well.

Recent Videos
Brian Slomovitz, MD, MS, FACOG discusses the use of new antibody drug conjugates for treating patients with various gynecologic cancers.
Developing novel regimens may continue to improve survival outcomes of patients with advanced cervical cancer following the FDA approval of pembrolizumab and chemoradiation, says Jyoti S. Mayadev, MD.
Treatment with pembrolizumab plus chemoradiation appears to be well tolerated with no detriment to quality of life among those with advanced cervical cancer.
Jyoti S. Mayadev, MD, says that pembrolizumab in combination with chemoradiation will be seamlessly incorporated into her institution’s treatment of those with FIGO 2014 stage III to IVA cervical cancer following the regimen’s FDA approval.
Domenica Lorusso, MD, PhD, says that paying attention to the quality of chemoradiotherapy is imperative to feeling confident about the potential addition of pembrolizumab for locally advanced cervical cancer.
Guidelines from the Society of Gynecologic Oncology may help with managing the ongoing chemotherapy shortage in the treatment of patients with gynecologic cancers, according to Brian Slomovitz, MD, MS, FACOG.
Interim data reveal favorable responses in patients with low-grade serous ovarian cancer treated with avutometinib plus defactinib, according to Susana N. Banerjee, MD.
Brian Slomovitz, MD, MS, FACOG, notes that sometimes there is a need to substitute cisplatin for carboplatin, and vice versa, to best manage gynecologic cancers during the chemotherapy shortage.
Related Content