SLN Biopsy Alone Can Reduce Surgical Morbidity in Early Cervical Cancer

The use of sentinel lymph node (SLN) biopsy alone in women with early cervical cancer resulted in less surgical morbidity without a significant increase in the risk of recurrence, according to a new prospective study.

SLN biopsy is known to have several benefits in this patient population, including the ability to detect micrometastases and to detect sentinel nodes in abnormal locations, said Patrice Mathevet, MD, PhD, of the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland. In spite of those benefits, though, pelvic lymphadenectomy is still routinely performed.

Mathevet presented results of the SENTICOL2 trial, which randomized women to either SLN biopsy alone or to biopsy plus pelvic lymph node dissection, at the Society of Gynecologic Oncology (SGO) Annual Meeting in National Harbor, Maryland. All patients had stage IA/IB1/IIA1 cervical cancer, with no sign of metastasis at preoperative workup.

A total of 267 patients were included across 30 centers between 2009 and 2012, but 61 were not randomized due to unilateral or no SLN detection, or various other reasons. That left a total of 206 patients to be randomized, with 105 undergoing SLN biopsy only and 101 undergoing a control SLN biopsy and a pelvic lymph node dissection; no false negative cases were found in the pelvic lymph node dissection group. Patients had a median of three SLNs, with a median of one per side.

There was significantly reduced surgical morbidity in the SLN biopsy alone group, in 31.4% of patients compared with 51.5% of lymph node dissection patients (P = .0046). Most morbidity was deemed “minor” (grade 1–2); one SLN biopsy patient and six dissection patients had “major” morbidity (grade 3–4; P = .061). There were no significant differences between the groups with regard to recurrence-free and overall survival. There were two cases in the SLN biopsy group of isolated lymph nodal recurrence (none in the dissection group), which occurred at 1.7 and 4.4 years after surgery. Mathevet said there was no evident reason for the recurrence; one patient died due to disease progression, while the other is free of disease after 6 years.

The investigators also tested quality-of-life measures using the SF36 questionnaire, and found significantly better scores with SLN biopsy alone. Leg lymphedema at the lower root and mid-tight circumferences was reduced with SLN biopsy as well, as were leg heaviness and leg tiredness.

The study, Mathevet noted in his presentation, suggests that “morbidity-sparing approaches in cervical cancer treatment incorporating SLN biopsy alone” can be effective without increasing risk of recurrence.