Jaydip Bhaumik

Validation of Sentinel Lymph Node Biopsy in Robotic Endometrial Cancer Staging Surgery: Results From a High-Volume Center in India

PURPOSE Lymph node involvement is one of the most important factors influencing recurrence and survival in patients with endometrial cancer (EC). However, the therapeutic role of lymphadenectomy in early-stage disease has been called into question. Sentinel lymph node (SLN) mapping may be an acceptable alternative to omitting lymphadenectomy or performing a complete lymphadenectomy in patients with EC. To validate SLN biopsy (SLNB) using indocyanine green (ICG) dye and near-infrared imaging in the background of comprehensive lymphadenectomy in patients with EC undergoing robotic staging surgery at Tata Medical Center. METHODS This was a single-center, prospective observational study involving patients with EC undergoing robotic staging. Patients received a standardized cervical injection of ICG at the 3- and 9-o'clock positions, with the dye reinjected if mapping failed. Depending on preoperative histology and radiological staging, patients had SLNB or comprehensive systematic lymphadenectomy in addition to SLNB. RESULTS The study included 105 female patients, of whom 71 underwent SLN and full lymphadenectomy and 34 underwent only SLN. There was bilateral mapping in 92 (87.61%) patients, with no mapping in one patient. In 18 patients, ICG dye was reinjected. With the exception of one, the rest had successful mapping after reinjection. The sensitivity of the SLN-ICG algorithm was 92.3%, and the negative predictive value was 98.3%. Ultrastaging necessitated upstaging in 8.57% of patients. CONCLUSION With a very high negative predictive value, SLN mapping with ICG dye has a high degree of diagnostic accuracy in detecting lymph node metastases in EC.

18F‐fluorodeoxyglucose PET‐CT‐guided pelvic chemoradiation therapy using helical tomotherapy for locally advanced carcinoma cervix without para‐aortic nodal disease: Clinical and patient‐reported outcomes from a prospective phase 2 study

AbstractIntroductionLocally advanced carcinoma cervix (LACC) is a heterogeneous disease with variable combinations of primary tumour extensions with or without nodal involvement. Metabolic information from 18 fluro‐deoxyglucose positron emission tomography combined with contrast‐enhanced computerized tomography (FDG PET‐CT) may potentially augment treatment decision‐making for LACC. This study ascertained FDG‐PET CT influence on chemoradiation therapy (CTRT) decisions in LACC. We report oncologic and patient‐reported outcome measures (PROMs).MethodsFDG PET‐CT scans were reviewed independently by two nuclear medicine specialists and two radiation oncologists. Pelvic CTRT plan digressions were documented and therapy was adapted accordingly. Pelvis radiation (50 Gy/25#/5 weeks) using tomotherapy with weekly cisplatin was used in node‐negative disease. Dose‐escalated simultaneous integrated boost (SIB) 60 Gy/25#/5 weeks was delivered to involved pelvic nodes. All received brachytherapy. Post‐treatment PET‐CT scans were at 6 months. Functional assessment of cancer therapy scores were calculated at baseline, treatment completion, 3 months, 1 year and 3 years.ResultsBetween November 2015 and January 2018, 85 patients were screened, and 77 consented. Extrapelvic disease was seen in 12 (16%) patients (9 para‐aortic nodes, 2 distant metastases and 1 synchronous carcinoma breast); 60 patients were included in the final analysis. Decision changes were seen in 10/77 (13%) screened, 8/60 (13%) included and 32 (53.3%) received SIB. Post‐treatment, 27 (45%) had grade 2 GI/GU/GYN toxicity, one (2%) had grade 3 GI and five (8.3%) had grade 3 neutropenia. At median follow‐up of 54.2 months (95% CI 52.8–58.3), 5‐year local failure, pelvic nodal and para‐aortic nodal‐free survival were 86.8% (95% CI 78.0–96.6), 85.2% (95% CI 76.1–95.3) and 85.2% (95% CI 76.2–95.4). Functional assessment of cancer therapy trial outcome index (FACT TOI) improved by 10.43 at 3 months with no further decline. Grade 3 toxicity was noted for abdominal pain in one (1.7%), cystitis in four (6.7%) and lymphoedema in one (1.7%) at 5 years.ConclusionPET‐CT resulted in major decision changes in 13%. PET‐adapted CTRT was associated with acceptable toxicity, encouraging long‐term survival and improvement in PROMS.