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No lymphadenectomy for advanced ovarian cancer without suspicious nodes

Presented by
Prof. Jean-Marc Classe, Nantes Université, France
Conference
ASCO 2024
Trial
Phase 3, CARACO
Doi
https://doi.org/10.55788/750fc68a
Adding lymphadenectomy to complete cytoreductive surgery (in primary surgery or after neoadjuvant chemotherapy) in patients with advanced ovarian cancer with no suspicious nodes did not improve survival and increases severe morbidity in the phase 3 CARACO trial.

In patients with advanced ovarian cancer, abdominal retroperitoneal lymphadenectomy must be performed in case of bulky suspicious lymph nodes. In the absence of suspicious bulky lymph nodes, systemic retroperitoneal lymphadenectomy reveals lymph node involvement in almost 50% of cases. Previously, the LION trial (NCT00712218) demonstrated the lack of benefit of adding retroperitoneal lymphadenectomy to primary surgery for advanced epithelial ovarian cancer with clinically negative lymph nodes [1].

The phase 3 CARACO trial (NCT01218490) aimed to evaluate the benefit of systemic retroperitoneal lymphadenectomy at interval surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer and clinically negative lymph nodes. Prof. Jean-Marc Classe (Nantes Université, France) presented the results [2].

CARACO enrolled 379 participants (FIGO stage III–IVA, clinically lymph node-negative) who were 1:1 randomised to surgery with retroperitoneal lymphadenectomy (RPL arm) or surgery without retroperitoneal lymphadenectomy (no-RPL arm). The median number of resected lymph nodes in the RPL arm was 28. In both arms, approximately 25% of participants underwent primary surgery, and 75% of participants underwent interval surgery after neoadjuvant chemotherapy.

No statistically significant differences were observed in progression-free survival (PFS) and overall survival (OS) between the treatment arms (total population). The median PFS was 14.8 months in the no-RPL arm and 18.6 months in the RPL arm (HR 0.96; P=0.712); median OS was 48.9 versus 58.8 months, respectively (HR 0.92; P=0.489). Likewise, in participants who underwent interval surgery, no statistically significant difference in survival was observed between the no-RPL and RPL arms (PFS: HR 0.89; P=0.374; OS: HR 0.86; P=0.280). Further, RPL was associated with increased severe morbidity (transfusion or blood loss, urinary injury, re-interventions).

“Adding retroperitoneal lymphadenectomy to interval surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer with clinically negative lymph nodes does not improve survival,” concluded Prof. Classe.

  1. Harter P, et al. N Engl J Med 2019; 380: 822-832.
  2. Classe JM, et al. Omission of lymphadenectomy in patients with advanced epithelial ovarian cancer treated with primary or interval cytoreductive surgery after neoadjuvant chemotherapy: The CARACO phase III randomized trial. Abstract LBA5505, ASCO Annual Meeting 2024, 31 May–4 June, Chicago, IL, USA.

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