Sentinel Concept in Early Stage Cervical Cancer

Charité University Medicine Berlin

Status: Unknown

Conditions: Cervical Cancer

Treatments: Procedure: Lymphadenectomy in cervical cancer

Study type: Interventional

Funder types: Other

Identifiers

NCT01157962

EA1/207/09

Details and patient eligibility

About

Aim of present study is to inspect, if the removal alone of sentinel lymph nodes in women with early Cervix Carcinoma lead to, at equal length, overall survival like entire systematic dissection of lymph node and at the same time is accompanied with a considerably reduction of associated intra and post operative complications of lymph node dissection.

For this purpose were randomized about 1200 patients with histological assured cervix carcinoma in stages FIGO 1a1 L1 V0, FIGO 1a2 L0 or L1 V0, FIGO1b1 L0 or L1 V0= 2 cm randomization. In the branch A takes place exclusively dissection sentinel lymph node, in the branch B takes place entire pelvic lymph node dissection. Afterwards takes place in tumor free lymph nodes the removal of uterus by a radical hysterectomy or, in presence of the wish of children, radical trachelectomy. In affected tumoural lymph nodes takes place systematic pelvic and peri aortic lymph node dissection followed by primary Radiochemotherapy.

Primary end point is overall survival; this for both groups must be equal. Secondary end point is peri- and postoperative morbidity inclusive quality of life, the benefits for women must be evident with sentinel- lymph node dissection, don't have to show for both groups any significant difference.

Full description

After randomization and assignment to experimental or control group lymphadenectomy is carried out.

Four different techniques can be used: 1) laparoscopic transperitoneal 2) laparoscopic retroperitoneal 3) open extraperitoneal 4) open transperitoneal. Radioactive labeling of sentinel-lymph nodes with 99technetium-marked colloid and/or patent blue is carried out. On the day prior to the operation 50mBq 99technetium or on the day of operation 10 mBq 99technetium is injected subepithelially in the cervix at 12, 3, 6 and 9 o'clock. Preoperatively 4 cc patent blue are injected in the same manner subepithelially. At the beginning of surgery parametrial tumor involvement, intrabdominal tumor dissemination, invasion of vesica-cervical and recto-vaginal septum are excluded. A lavage of cul-de-sac for cytological analysis is performed. The retroperitoneum is opened lateral of iliac vessels and blue colored lymph or radioactive nodes are removed. Sentinel- lymph node's radioactive signal is documented in counts per second (cps).

If no sentinel-lymph node is detected, complete pelvic lymph node dissection is carried out. If tumor involved pelvic lymph nodes are shown, paraaortic lymph node dissection is carried out. If sentinel- or pelvic lymph nodes are quoted as tumor free at frozen sections, radical hysterectomy or radical trachelectomy is performed. Radical hysterectomy follows in an extension a type-2 variation. In patients with positive lymph nodes in frozen section or in definitive histo-pathology primary chemoradiation is performed.

Enrollment: 1,600 estimated patients

Sex: Female

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Karnofsky index
• Patients aged 18-70
• Histological assured cervix cancer (Squamous epithelium- or Adenoids cancer, adenosquamous cancer)
• Stadium FIGO from 1a1 L1 V0, FIGO 1a2 L0 or L1 V0, till FIGO 1b1 L0 or L1 V0 ≤ 2cm
• Completed and signed consent form
• Cooperation qualities of patients
• Performed explanation patients and written consent

Exclusion criteria

• Tumour thickness > 2cm, FIGO- staging > 1b1
• Neuroendocrine tumoural or mixed types with neuroendocrine tissues
• Tumoural invasion in vascular system (V1)
• Pregnancy, during lactation women without reliable contraception during radiochemotherapy
• Existing malignant diseases (Exception: basalioma of the skin)
• Radiotherapy of pelvis in anamnesis
• Severe internal associated diseases (Myocardial infarction, Heart pathology, Heart insufficiency NYHA III/IV, Severe chronic obstructive bronchopulmonary disease, kidney insufficiency, diabetes mellitus poorly regulated, uncontrolled infections) Anaesthesia not allowed
• Psychiatric diseases, which put off participating and after care
• HIV infection, or rather AIDS disease
• Drug addicted
• Precedent motorial or sensorial Polyneuropathies>CTC grade 1

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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1,600 participants in 2 patient groups

Group A Sentinel lymphadenectomy

Experimental group

Description:

In group A exclusively sentinel lymphadenectomy is performed

Treatment:

Procedure: Lymphadenectomy in cervical cancer

Group B radical pelvine lymphadenectomy

Active Comparator group

Description:

in group B radical systematic pelvic lymphadenectomy is done. In patients with tumor free lymph nodes either radical hysterectomy or, in women seeking parenthood, radical trachelectomy is performed. If lymph nodes are tumor-involved systematic pelvic and paraaortic lymphadenectomy followed by primary chemoradiation is recommended.

Treatment:

Procedure: Lymphadenectomy in cervical cancer