Impact of Sentinel Lymph Node Mapping on Patient Reported Lower Extremity Limb Dysfunction in Stage I Endometrial Cancer
Purpose
This phase III trial compares the effect of sentinel lymph node mapping to standard lymph node dissection in reducing the risk of swelling in the legs (lymphedema) in patients undergoing a hysterectomy for stage I endometrial cancer. Standard lymph node dissection removes lymph nodes around the uterus during a hysterectomy to look for spread of cancer from the uterus to nearby lymph nodes. Sentinel lymph node mapping uses a special dye and camera to look for cancer that may have spread to nearby lymph nodes. Comparing the results of the procedures may help doctors predict the risk of long-term swelling in the legs.
Condition
- Stage I Uterine Corpus Carcinoma or Carcinosarcoma AJCC v8
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Sex
- Female
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- Histologically proven diagnosis of endometrial cancer based on endometrial sampling with a plan to undergo laparoscopic or robotic hysterectomy and lymphatic assessment as part of primary management. Biopsy must be performed within 90 days prior to registration - Clinical stage I endometrial cancer based on the following diagnostic workup: - History/physical examination within 30 days prior to registration is reassuring for the absence of metastatic disease - Age >= 18 years - Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2 - Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial - The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information - Patients must speak English, Spanish, or Korean
Exclusion Criteria
- Patients whom the surgeon believes is not a candidate for pelvic lymphadenectomy due to medical comorbidities or other technical challenges (i.e. morbid obesity or prior surgery) - History of chemotherapy or immunotherapy for the treatment of endometrial cancer. Progestin-containing therapies such as megestrol, medroxyprogesterone, or levonorgestrel-containing intrauterine device (IUD) are acceptable - History of radiation to the pelvis, groin or lower extremities, or surgery to the pelvic lymph nodes or inguinal lymph nodes - Patients who are going to undergo another elective surgery during the same operative event as their hysterectomy (i.e., sacrocolpopexy, cholecystectomy) - Patients with severe, active co-morbidity defined as follows: - History of patient or provider identified lower extremity lymphedema - History of patient or provider identified chronic lower extremity swelling - History of lower extremity or pelvic deep venous thromboembolism within 90 days of registration - History of lower extremity cellulitis within 90 days of registration
Study Design
- Phase
- Phase 3
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Primary Purpose
- Supportive Care
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental Arm 1 (sentinel lymph node mapping) |
Patients receive ICG dye via injection and undergo sentinel lymph node mapping and excision during standard minimally invasive hysterectomy. Lymph nodes around the uterus may be removed if the mapping and excision cannot be completed. Successful mapping requires no additional removal of lymph nodes. Patients also undergo imaging as clinically indicated and optional blood sample collection throughout the study. |
|
|
Experimental Arm 2 (sentinel lymph node mapping, pelvic lymphadenectomy) |
Patients receive ICG dye via injection and undergo sentinel lymph node mapping and excision during standard minimally invasive hysterectomy. Additional lymph nodes around the uterus are removed per standard of care. Patients also undergo imaging as clinically indicated and optional blood sample collection throughout the study. |
|
Recruiting Locations
Coral Gables, Florida 33146
Site Public Contact
305-243-2647
Deerfield Beach, Florida 33442
Site Public Contact
305-243-2647
Doral, Florida 33166
Miami, Florida 33136
Site Public Contact
305-243-2647
Miami, Florida 33176
Site Public Contact
305-243-2647
North Miami, Florida 33181
Plantation, Florida 33324
Site Public Contact
305-243-2647
Augusta, Georgia 30912
Chicago, Illinois 60611
Warrenville, Illinois 60555
Carmel, Indiana 46032
Indianapolis, Indiana 46202
Marrero, Louisiana 70072
Metairie, Louisiana 70006
Metairie, Louisiana 70006
New Orleans, Louisiana 70112
New Orleans, Louisiana 70112
Baltimore, Maryland 21201
Site Public Contact
800-888-8823
Bel Air, Maryland 21014
Site Public Contact
443-643-3010
Detroit, Michigan 48201
Farmington Hills, Michigan 48334
Flint, Michigan 48532
Edina, Minnesota 55435
Maple Grove, Minnesota 55369
Maplewood, Minnesota 55109
Princeton, Minnesota 55371
Saint Paul, Minnesota 55101
Wyoming, Minnesota 55092
Springfield, Missouri 65804
Site Public Contact
417-269-4520
Kearney, Nebraska 68845
Omaha, Nebraska 68118
Site Public Contact
402-559-5600
Omaha, Nebraska 68198
Las Vegas, Nevada 89106
Site Public Contact
702-851-4672
Oklahoma City, Oklahoma 73104
Providence, Rhode Island 02905
Site Public Contact
401-274-1122
Dallas, Texas 75235
Dallas, Texas 75390
Fort Worth, Texas 76104
Houston, Texas 77030
Site Public Contact
713-792-3245
Richardson, Texas 75080
Charlottesville, Virginia 22908
More Details
- Status
- Recruiting
- Sponsor
- NRG Oncology
Study Contact
Detailed Description
PRIMARY OBJECTIVES: I. To compare the rates of lower extremity limb dysfunction (defined as a >= 4-point increase in Gynecologic Cancer Lymphedema Questionnaire [GCLQ] symptom score from baseline) in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy: Ia. Sentinel lymph node mapping and excision followed by side-specific lymphadenectomy on sides without a sentinel lymph node (SLN) identified according to a National Comprehensive Cancer Network (NCCN) guidelines approved algorithm (Arm 1); Ib. Sentinel lymph node mapping and excision according to an NCCN Guidelines approved algorithm followed by bilateral pelvic +/- para-aortic lymphadenectomy (Arm 2). SECONDARY OBJECTIVE: I. To compare changes in lower extremity limb circumference in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy. II. To validate the test characteristics of a SLN mapping algorithm including SLN detection rates, rate of perioperative complications, rate of identifying lymphatic metastases, and detection of micrometastases using pathologic ultra-staging. EXPLORATORY OBJECTIVES: I. To compare adjuvant therapy decisions in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy. II. To explore the impact of patient characteristics (age, body mass index [BMI], race), extent of lymph node dissection, and adjuvant therapy decisions (radiation, chemotherapy) on the development of lower extremity limb dysfunction - as well as their interaction with lymph node assessment strategies. III. To evaluate the cost-effectiveness of SLN mapping with or without completion of lymphadenectomy for endometrial cancer. SAFETY OBJECTIVE: I. To compare progression free and overall survival in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy. OUTLINE: Patients are randomized to 1 of 2 arms. ARM 1: Patients receive ICG dye via injection and undergo sentinel lymph node mapping and excision during standard minimally invasive hysterectomy. Lymph nodes around the uterus may be removed if the mapping and excision cannot be completed. Successful mapping requires no additional removal of lymph nodes. ARM 2: Patients receive ICG dye via injection and undergo sentinel lymph node mapping and excision during standard minimally invasive hysterectomy. Additional lymph nodes around the uterus are removed per standard of care. Patients in both arms also undergo imaging as clinically indicated and optional blood sample collection throughout the study. After completion of study intervention, patients are followed every 3 months for one year and at 18 and 24 months.