Sentinel Lymph Node Biopsy for Cervical Cancer Patients – What’s It Gonna Take?

Abstract

How many times have you read a paper that concluded, “More studies are needed”? As a field, when do we stop writing “more studies are needed” and start implementing the topic of study into our standard practice? Sometimes it takes a “definitive” study or studies, such as the adoption of sentinel nodes in the treatment of vulvar cancer [ 1 Levenback C.F. Ali S. Coleman R.L. Gold M.A. Fowler J.M. Judson P.L. Bell M.C. De Geest K. Spirtos N.M. Potkul R.K. Leitao Jr., M.M. Bakkum-Gamez J.N. Rossi E.C. Lentz S.S. Burke II, J.J. Van Le L. Trimble C.L. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J. Clin. Oncol. 2012; 30: 3786-3791 Crossref PubMed Scopus (260) Google Scholar , 2 Van der Zee A.G. Oonk M.H. De Hullu J.A. Ansink A.C. Vergote I. Verheijen R.H. Maggioni A. Gaarenstroom K.N. Baldwin P.J. Van Dorst E.B. Van der Velden J. Hermans R.H. Van der Putten H. Drouin P. Schneider A. Sluiter W.J. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J. Clin. Oncol. 2008; 26: 884-889 Crossref PubMed Scopus (592) Google Scholar ]. Sometimes, even after completing what many would consider the definitive studies, there is still widespread resistance to adoption, such as the utilization of intraperitoneal chemotherapy in the treatment of ovarian cancer [ [3] Armstrong D.K. Bundy B. Wenzel L. Huang H.Q. Baergen R. Lele S. Copeland L.J. Walker J.L. Burger R.A. Gynecologic Oncology G. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N. Engl. J. Med. 2006; 354: 34-43 Crossref PubMed Scopus (2234) Google Scholar ]. And sometimes, we adopt procedures as standard before the studies are even complete. An example of this scenario is the widespread uptake of the laparoscopic approach in the surgical treatment of endometrial and cervical cancers well ahead of completion of the definitive clinical trials [ 4 Walker J.L. Piedmonte M.R. Spirtos N.M. Eisenkop S.M. Schlaerth J.B. Mannel R.S. Barakat R. Pearl M.L. Sharma S.K. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J. Clin. Oncol. 2012; 30: 695-700 Crossref PubMed Scopus (504) Google Scholar , 5 Obermair A. Gebski V. Frumovitz M. Soliman P.T. Schmeler K.M. Levenback C. Ramirez P.T. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J. Minim. Invasive Gynecol. 2008; 15: 584-588 Abstract Full Text Full Text PDF PubMed Scopus (136) Google Scholar , 6 Janda M. Gebski V. Forder P. Jackson D. Williams G. Obermair A. Committee L.T. Total laparoscopic versus open surgery for stage 1 endometrial cancer: the LACE randomized controlled trial. Contemp. Clin. Trials. 2006; 27: 353-363 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar ].