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RECRUITING

NCT04073706

PHASE3

Sentinel Node Biopsy in Endometrial Cancer

Sponsor: Queensland Centre for Gynaecological Cancer

View on ClinicalTrials.gov

Summary

Endometrial cancer (EC) is the most common gynaecological cancer. Current treatment of EC typically includes removal of the uterus and to determine the extent of the disease (removal of fallopian tubes, ovaries \& if required a lymph node dissection (surgical staging)). While lymph node dissection may be valuable to guide the need for adjuvant treatment (chemo or radiotherapy) after surgery, it has been a topic of controversy for the last 30 years. In some patients it causes morbidity, specifically lymphoedema. This recently has been replaced with sentinel node biopsy (SNB). It requires an injection of a dye into the cervix with specific equipment \& surgical dissection of the lymph node in which the dye first becomes visible. Despite this promising proposition \& similar to a lymph node dissection, the value to patients, cost effectiveness \& potential harms (e.g. lymphedema) of SNB compared to no-node dissection in EC has never been established. Aim: determine the value of SNB for patients, the healthcare system and exclude detriment to patients using a randomised approach 1:1. Stage 1 - 444 patients. Stage 2 additional 316 patients. Primary Outcome Stage 1: Proportion of participants returning to usual daily activities at 12 months from surgery using the EQ-5D which will determine when women in both groups can return to their usual activities. Primary Outcome Stage 2: Treatment non-inferiority as evaluated by disease-free survival status at 4.5 years post-surgery, as measured by the time interval between the date of randomisation and date of first recurrence. Confirmation of recurrent disease will be ascertained through clinical assessment, radiological work-up and/or histological results.

Official title: A Phase III Randomised Clinical Trial Comparing Sentinel Node Biopsy With No Retroperitoneal Node Dissection in Apparent Early-Stage Endometrial Cancer

Key Details

Gender

FEMALE

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

760

Start Date

2021-01-18

Completion Date

2031-02

Last Updated

2026-01-30

Healthy Volunteers

Conditions

Endometrial Cancer Stage I Sentinel Lymph Node Surgery

Interventions

PROCEDURE

TH BSO with SNB Note: If participants (≤45yo), Grade 1 endometrial adenocarcinoma with myometrial invasion <50%, wish to retain their ovaries a BSO may be omitted

Removal of uterus, tubes and ovaries with a sentinel node biopsy. A tracer dye (ICG) +/- Methylene Blue Dye is injected into the surroundings of the primary tumour, it is transported via local lymphatic channels towards the draining lymphatic basin, and the first node that the tracer reaches is called the "sentinel node". These one or two nodes are thought to be first involved with cancer spread.

PROCEDURE

TH BSO without retroperitoneal node dissection Note: If participants (≤45yo), Grade 1 endometrial adenocarcinoma with myometrial invasion <50%, wish to retain their ovaries a BSO may be omitted

Removal of uterus, tubes and ovaries without retroperitoneal node dissection

Inclusion Criteria: 1. Females, over 18 years, with histologically confirmed primary epithelial cancer of the endometrium of any cell type or uterine carcinosarcoma (mixed malignant mullerian tumour); 2. Clinically stage I disease (disease confined to body of uterus); 3. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; 4. Signed written informed consent; 5. Participant must meet criteria for a laparoscopic or robotic surgical approach as determined by the treating physician (e.g. suitable for TH BSO, ability to tolerate Trendelenberg positioning) 6. All available clinical evidence (physical examination findings, or medical imaging such as CT, MRI or ultrasound) demonstrates no evidence of extrauterine disease 7. Myometrial Invasion on MRI of not more than 50%. (Only if participant is \<45yo, has ONLY Grade 1 EAC and wishes to retain their ovaries). 8. Negative (serum or urine) pregnancy test ≤ 30 days of surgery in pre-menopausal women and women \< 2 years after the onset of menopause. Exclusion Criteria: 1. Evidence of extrauterine disease (apparent involvement of cervix, vagina, parametria, adnexa, lymph nodes, bladder, bowel or distant sites) by clinical examination and/or through medical imaging. 2. Enlarged retroperitoneal pelvic and/or aortic lymph nodes (\>1 cm) on medical imaging; 3. Estimated life expectancy of less than 6 months; 4. Patients who have absolute contraindications for adjuvant radiotherapy and/or chemotherapy; 5. Patients who have previously received radiation treatment to the pelvis 6. Serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator); 7. Patient compliance and geographic proximity that do not allow adequate follow-up; 8. Patients with allergy to Indocyanine Green (ICG) 9. Patients who have had previous retroperitoneal surgery 10. Patients who require a retroperitoneal (pelvic +/- para-aortic) lymph node dissection (lymphadenectomy) 11. Other prior malignancies \<5 years before inclusion, except for successfully treated keratinocyte skin cancers, or ductal carcinoma of the breast insitu 12. Uterine perforation during endometrial tissue sampling

Locations (19)

Houston Methodist Hospital

Houston, Texas, United States

Hospital Britanico

Buenos Aires, Ciudad Autónoma de Buenos Aires (caba), Argentina

Chris O'Brien Lifehouse

Camperdown, New South Wales, Australia

Liverpool Hospital

Liverpool, New South Wales, Australia

The Wesley Hospital

Auchenflower, Queensland, Australia

Buderim Private Hospital

Buderim, Queensland, Australia

North West Private Hospital

Everton Park, Queensland, Australia

Royal Brisbane and Women's Hospital

Herston, Queensland, Australia

Mater Hospital

South Brisbane, Queensland, Australia

Gold Coast University Hospital

Southport, Queensland, Australia

St Andrews War Memorial Hospital

Spring Hill, Queensland, Australia

Mercy Hospital for Women

Heidelberg, Victoria, Australia

Royal Women's Hospital

Parkville, Victoria, Australia

Hospital de Base

São José do Rio Preto, São Paulo, Brazil

Fundacao Antonio Prudente, AC Camargo Cancer Center

São Paulo, São Paulo, Brazil

Hospital Israelita Albert Einstein

São Paulo, São Paulo, Brazil

Centro de tratamiento e investigación sobre Cáncer Luis Carlos Sarmiento Angulo

Bogotá, Bogotá, Distrito Capital, Colombia

Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)

Udine, Via Pozzuolo, Italy

National University Hospital and National University Cancer Institute

Singapore, NUH Zone B, Singapore