114 Lower-limb lymphedema after sentinel lymph node biopsy in cervical cancer patients

R Poncová,C Köhler,F Frühauf ,Octavio Arencibia-Sánchez ,Ignacio Zapardiel ,Jordi Ponce ,Peter Kaščák ,Martina Borčinová ,Simone Marnitz ,Almerinda Petiz ,Michal Felsinger ,Jaroslav Klát ,Borek Sehnal ,Aureli Torné ,Laura Lay ,Jiří Jarkovský ,Kamil Zalewski ,Roman Kocián ,R Pilka,David Cibula

doi:10.1136/ijgc-2021-esgo.7

Abstract

<h3>Introduction/Background*</h3> Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. <h3>Methodology</h3> In a prospective international multicenter trial SENTIX, the group of 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy was prospectively evaluated using both objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. The characteristics of the patients are summarized in table 1. <h3>Result(s)*</h3> The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10-19%), 9.2% for moderate LLL (LVI 20-39%), while only one patient (0.7%) developed severe LLL (LVI >40%). The median interval to LLL onset was nine months (figure 1). A transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. <h3>Conclusion*</h3> Contrary to the expectations, the replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed. <h3>Trial registration</h3> ClinicalTrials.gov: NCT02494063 <h3>Funding</h3> This work was supported by Charles University in Prague (UNCE 204065 and PROGRES Q28/LF1) and by a grant from the Czech Health Research Council (NV19-03-00023). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. <h3>Conflicts of Interest</h3> The authors declare no conflict of interest.

Highlights

Introduction/Background* The accelerated US Food and Drug Administration approval of pembrolizumab validated the efficacy of anti-Progressive disease (PD)-(L)1 therapy for patients with recurrent/metastatic cervical cancer; the objective response rate (ORR) with pembrolizumab was 14.3% in patients with PDL1–expressing tumours
We aimed to identify a subgroup of patients with stage III-IV cervical cancer who benefit from Concurrent chemoradiotherapy (CCRT) with additional treatment
We retrospectively reviewed 120 patients with stage III-IV cervical cancer who were treated with CCRT from 2002 to 2018

Summary

Introduction

Introduction/Background* The accelerated US Food and Drug Administration approval of pembrolizumab validated the efficacy of anti-PD-(L)1 therapy for patients with recurrent/metastatic cervical cancer; the objective response rate (ORR) with pembrolizumab was 14.3% in patients with PDL1–expressing tumours. IN PATIENTS WITH FIGO STAGE III-IV CERVICAL Introduction/Background* Concurrent chemoradiotherapy (CCRT) has limited therapeutic efficacy for stage III-IV cervical cancer.

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