Feel the Bern.
Top Line: If cytoreduction improves survival in advanced ovarian cancer, could extended lymph node dissection do even better?
The Study: Optimal cytoreduction involves resecting as much visible disease as possible with the goal of having <1 cm of residual cancer. In the LION trial, nearly 1900 patients with FIGO IIB-IV ovarian cancer were enrolled prior to undergoing planned cytoreductive surgery such that no visible residual disease remained. Of these 1900, only one-third were able to undergo such a resection, and they were then randomized to +/- lymphadenectomy. Interestingly, nearly 60% of patients in the node dissection group had occult nodal mets. Unfortunately, though, nodal dissection had no therapeutic benefit. Median progression-free survival was 26 months and median overall survival was 65-70 months with no significant difference between groups. As would be expected, performing para-aortic and pelvic nodal dissections resulted in longer procedures, more complications, and more intensive post-op care. Tell ‘em Bernie: “These observations provide substance to the conviction that [...] nodes are not the predecessor of distant tumor spread but represent one manifestation of disseminated disease.”
Bottom Line: Elective pelvic and para-aortic lymph node dissection add significant morbidity without apparent therapeutic benefit in patients with optimally debulked, advanced ovarian cancer. | Harter, N Engl J Med 2019
The Study: Optimal cytoreduction involves resecting as much visible disease as possible with the goal of having <1 cm of residual cancer. In the LION trial, nearly 1900 patients with FIGO IIB-IV ovarian cancer were enrolled prior to undergoing planned cytoreductive surgery such that no visible residual disease remained. Of these 1900, only one-third were able to undergo such a resection, and they were then randomized to +/- lymphadenectomy. Interestingly, nearly 60% of patients in the node dissection group had occult nodal mets. Unfortunately, though, nodal dissection had no therapeutic benefit. Median progression-free survival was 26 months and median overall survival was 65-70 months with no significant difference between groups. As would be expected, performing para-aortic and pelvic nodal dissections resulted in longer procedures, more complications, and more intensive post-op care. Tell ‘em Bernie: “These observations provide substance to the conviction that [...] nodes are not the predecessor of distant tumor spread but represent one manifestation of disseminated disease.”
Bottom Line: Elective pelvic and para-aortic lymph node dissection add significant morbidity without apparent therapeutic benefit in patients with optimally debulked, advanced ovarian cancer. | Harter, N Engl J Med 2019
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