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Intermediate/high risk endometrial cancer shows locoregional recurrence rates up to 20%. Also in so called low-risk disease 5-10% incidence of nodal metastasis is reported. Although adjuvant radiotherapy may reduce these recurrences there has been no survival benefit. To avoid toxicity of irradiation and preserve the full potential of radiotherapy for salvage treatment of recurrences surgery should avoid locoregional recurrence. According to the concept of ontogenetically based compartmental surgery it may be suggested that this may be achieved by PMMR and therapeutic LNE as it has been already shown for TMMR in cervical cancer and TME in rectal cancer. First, monocentric data have shown feasibility and safety of this approach and are promising with respect to reduce locoregional recurrence rate significantly. On parallel it has also been convincingly shown that sentinel node detection shows a high level of accuracy in precluding nodal involvement in endometrial cancer. Thus, unnecessary complete lymphadenectomy may be avoided in patients with proven node negative disease. However, this procedure is aimed on diagnostic and not therapeutic goals. Nevertheless, therapeutically it fits well in the surgical concept of compartmental surgery indicating the peripheral border of therapeutic surgical approach. This leads to the concept to resect the embryologically determined tissue of risk en bloc together with the "sentinel nodes" of the draining lymph compartment (module I). In case of positive node extended therapeutic pelvic and paraaortic lymphadenectomy (module II) may be indicated. This should now be evaluated in a European collaborative observational trial. The surgical arm (cohort A) will include Patients who have received surgical treatment (module I) and in case of positive nodes or enhanced risk for isolated positive paraaortic nodes (module II) and don't want to receive adjuvant radiation therapy; in intermediate/high risk situations, however, adjuvant chemotherapy should be offered to these patients. For patients with high-risk carcinomas who do not want to be treated with the modular concept, the option of receiving systematic lymphadenectomy during primary surgery will be given. Patients who prefer to be treated according current clinical practice will be asked to participate in cohort B to be observed as concomitant control and will be treated according to current clinical practice based on the European ESMO/ESGO/ESTRO-Guidelines. Primary endpoint will be loco-regional recurrence and recurrence free survival. Follow up is planned for 5 years following date of first surgery (module I).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cohort A | PMMR + TCL, followed by systematic lymphadenectomy in node positive patients. |
| |
| Cohort B | Therapy according to actual guidelines |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Peritoneal Mesometrial Resetion + Targeted Compartmental Lymphadenectomy (PMMR+TCL) | Procedure | Peritoneal Mesometrial Resetion + Targeted Compartmental Lymphadenectomy (PMMR+TCL) |
| Measure | Description | Time Frame |
|---|---|---|
| Progression Free Survival | Time to recurrence or progression | 36 months |
| Intra- and postoperative complications, incidence of lymph oedema | 36 months |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | Time to death of any cause | 36 months |
| Rate of locoregional relapse and rate of distant metastases at 3 years. | 36 months |
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Inclusion Criteria:
or
Exclusion Criteria:
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Women with the primary diagnosis of histologically proven endometrial carcinoma: endometroid and non-endometroid FIGO stages I-III; Karnofsky-Index ≥ 70; unrestricted operability; Age >=18 years.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Paul Buderath, Dr. | Contact | +492017232442 | paul.buderath@uk-essen.de | |
| Rainer Kimmig, Prof. | Contact | +492017232441 | rainer.kimmig@uk-essen.de |
| Name | Affiliation | Role |
|---|---|---|
| Rainer Kimmig, Prof. | University Hospital, Essen | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital Essen, Department of Gynaecology | Recruiting | Essen | North Rhine-Westphalia | 45122 | Germany |
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| Pelvic organ functioning | Therapy-induced morbidity on bladder/urethra, rectum/bowel, vagina/vulva, assessed by the LENT-SOMA scoring system | 36 months |
| QoL | Quality of life by EORTC-QLQ-C30 questionnaire at 12 and 24 months after surgery. | 36 months |
| ID | Term |
|---|---|
| D016889 | Endometrial Neoplasms |
| ID | Term |
|---|---|
| D014594 | Uterine Neoplasms |
| D005833 | Genital Neoplasms, Female |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D014591 | Uterine Diseases |
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |
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