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Brief Title: Impact of Sentinel Lymph Node Mapping on Patient Reported Lower Extremity Limb Dysfunction in Stage I Endometrial Cancer
Official Title: A Phase III Trial of the Impact of Sentinel Lymph Node Mapping on Patient Reported Lower Extremity Limb Dysfunction in Endometrial Cancer
Study ID: NCT05646316
Brief Summary: This phase III trial compares the effect of sentinel lymph node mapping to standard lymph node dissection in reducing the risk of swelling in the legs (lymphedema) in patients undergoing a hysterectomy for stage I endometrial cancer. Standard lymph node dissection removes lymph nodes around the uterus during a hysterectomy to look for spread of cancer from the uterus to nearby lymph nodes. Sentinel lymph node mapping uses a special dye and camera to look for cancer that may have spread to nearby lymph nodes. Comparing the results of the procedures may help doctors predict the risk of long-term swelling in the legs.
Detailed Description: PRIMARY OBJECTIVES: I. To compare the rates of lower extremity limb dysfunction (defined as a \>= 4-point increase in Gynecologic Cancer Lymphedema Questionnaire \[GCLQ\] symptom score from baseline) in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy: Ia. Sentinel lymph node mapping followed by side-specific lymphadenectomy on sides without a sentinel lymph node (SLN) identified according to a National Comprehensive Cancer Network (NCCN) guidelines approved algorithm (Arm 1); Ib. Sentinel lymph node mapping according to an NCCN Guidelines approved algorithm followed by bilateral pelvic +/- para-aortic lymphadenectomy (Arm 2). SECONDARY OBJECTIVE: I. To compare changes in lower extremity limb circumference in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy. II. To validate the test characteristics of a SLN mapping algorithm including SLN detection rates, rate of perioperative complications, rate of identifying lymphatic metastases, and detection of micrometastases using pathologic ultra-staging. EXPLORATORY OBJECTIVES: I. To compare adjuvant therapy decisions in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy. II. To explore the impact of patient characteristics (age, body mass index \[BMI\], race), extent of lymph node dissection, and adjuvant therapy decisions (radiation, chemotherapy) on the development of lower extremity limb dysfunction - as well as their interaction with lymph node assessment strategies. III. To evaluate the cost-effectiveness of SLN mapping with or without completion of lymphadenectomy for endometrial cancer. SAFETY OBJECTIVE: I. To compare progression free and overall survival in patients with apparent uterine confined endometrial cancer randomized to one of two lymphatic assessment strategies at time of hysterectomy. OUTLINE: Patients are randomized to 1 of 2 arms. ARM 1: Patients receive ICG dye via injection and undergo sentinel lymph node mapping during standard minimally invasive hysterectomy. Lymph nodes around the uterus may be removed if the mapping cannot be completed. Successful mapping requires no additional removal of lymph nodes. ARM 2: Patients receive ICG dye via injection and undergo sentinel lymph node mapping during standard minimally invasive hysterectomy. Additional lymph nodes around the uterus are removed per standard of care. Patients in both arms also undergo imaging as clinically indicated. After completion of study intervention, patients are followed every 3 months for one year and at 18 and 24 months.
Minimum Age: 18 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: FEMALE
Healthy Volunteers: No
George Washington University Medical Center, Washington, District of Columbia, United States
Northwestern University, Chicago, Illinois, United States
Northwestern Medicine Cancer Center Warrenville, Warrenville, Illinois, United States
IU Health North Hospital, Carmel, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, United States
West Jefferson Medical Center, Marrero, Louisiana, United States
East Jefferson General Hospital, Metairie, Louisiana, United States
Louisiana State University Health Science Center, New Orleans, Louisiana, United States
University Medical Center New Orleans, New Orleans, Louisiana, United States
University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, United States
Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, United States
Weisberg Cancer Treatment Center, Farmington Hills, Michigan, United States
McLaren Cancer Institute-Flint, Flint, Michigan, United States
Fairview Southdale Hospital, Edina, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove, Maple Grove, Minnesota, United States
Saint John's Hospital - Healtheast, Maplewood, Minnesota, United States
Fairview Northland Medical Center, Princeton, Minnesota, United States
Regions Hospital, Saint Paul, Minnesota, United States
Fairview Lakes Medical Center, Wyoming, Minnesota, United States
Mercy Hospital Springfield, Springfield, Missouri, United States
Alegent Health Bergan Mercy Medical Center, Omaha, Nebraska, United States
University of Nebraska Medical Center, Omaha, Nebraska, United States
Women's Cancer Center of Nevada, Las Vegas, Nevada, United States
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, United States
Paoli Memorial Hospital, Paoli, Pennsylvania, United States
Lankenau Medical Center, Wynnewood, Pennsylvania, United States
Women and Infants Hospital, Providence, Rhode Island, United States
Parkland Memorial Hospital, Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas, Dallas, Texas, United States
Houston Methodist Hospital, Houston, Texas, United States
Methodist Willowbrook Hospital, Houston, Texas, United States
Houston Methodist West Hospital, Houston, Texas, United States
UT Southwestern Clinical Center at Richardson/Plano, Richardson, Texas, United States
Houston Methodist Sugar Land Hospital, Sugar Land, Texas, United States
Houston Methodist The Woodlands Hospital, The Woodlands, Texas, United States
University of Virginia Cancer Center, Charlottesville, Virginia, United States
Name: Edward J Tanner
Affiliation: NRG Oncology
Role: PRINCIPAL_INVESTIGATOR