Page 91 - Hospital Authority Convention 2018

Masterclasses

M1.3 Multidisciplinary Management of Aortic Nodal Metastasis 10:45 Room 221
in Endometrial Cancer

Role of Pathologist in Lymph Node Assessment for Patients with Endometrial Cancer
Cheung ANY
Department of Pathology, The University of Hong Kong, Hong Kong HOSPITAL AUTHORITY CONVENTION 2018

In Hong Kong, endometrial cancer is currently the most commonly diagnosed gynaecological cancer and its incidence is
rising. Presence or absence of lymph node metastasis is one of the most important prognostic factors in endometrial cancer.
Surgical staging with lymphadenectomy facilitates the decision on adjuvant therapy but morbidity exists. Sentinel lymph node
(SLN) biopsy refers to the selective removal of the first lymph node or group of nodes draining a cancer. SLN can be identified
by injection of tracer dye into or close to the primary tumour. Intraoperative evaluation (frozen section) of SLN or non-SLN
is practised although limitation exists. Identification of the metastasis at SLN indicates the need for full lymphadenectomy.
This targeted sampling approach allows more thorough pathologic examination (ultrastaging) that can reduce the morbidity
due to complete lymphadenectomy. SLN biopsy is widely applied in patients with breast cancer and melanoma, and SLN
mapping has been proposed to be applied for staging patients with endometrial cancer particularly the low risk group
with minimal myometrial invasion or low-grade histotype. There is a variation in the methodology of how SLN or non-SLN
should be examined by pathologists, i.e. the number and intervals of haematoxylin and eosin stained deeper sections and
the use of cytokeratin immunohistochemistry to detect low volume metastasis. An optimal approach should be established
to provide efficient utilisation of resources in pathology service while ensuring a high standard of sensitivity and specificity
for patient management. The significance of low volume metastases (micrometastasis, and isolated tumour cells) versus
macrometastases in SLN and non-SLN is also an area of attention. Monday, 7 May 2018

M1.4 Multidisciplinary Management of Aortic Nodal Metastasis 10:45 Room 221
in Endometrial Cancer

The Influence of Para-aortic Nodal Status on Adjuvant Therapy for Endometrial Carcinoma
Siu SWK
Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
The para-aortic lymph node status of endometrial carcinoma affects the choice of adjuvant therapy after operation. Patients
with documented para-aortic lymph node involvement are at increased risk of recurrence and would benefit from some forms
of adjuvant therapy.
Chemotherapy plays an important role as adjuvant therapy for those with para-aortic lymph node involvement, and paclitaxel-
carboplatin is likely the most widely used regimen. Radiotherapy covering pelvic and/or para-aortic lymph nodes may also
help reduce the risk of local recurrence.
It is quite well accepted that patients with documented para-aortic lymph node involvement should be offered adjuvant
chemotherapy if not contraindicated, and adjuvant radiotherapy should also be considered. However, treating patients with
two modalities of adjuvant therapy will result in patients suffering from side effects from both treatments. There are also
variations in practices concerning the sequence of chemotherapy and radiotherapy, and the optimal sequence is yet to be
determined.
Giving extended field radiotherapy covering both pelvic and para-aortic lymph nodes would be challenging given the large
treatment volume and the amount of normal tissue involved in the radiotherapy treatment field, it may result in significant
acute and long-term treatment toxicities, limited dose of radiation that can be given especially to the para-aortic region.
Patients should be assessed concerning the optimal adjuvant therapy regimen balancing potential benefits and tolerance
to treatment. Multidisciplinary approach involving different specialties and multimodality treatment including optimally
performed surgery, adjuvant chemotherapy with or without adjuvant radiotherapy targeting at sites with high risk of
recurrence likely offers the best chance of survival for these patients.

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