Sentinel Node Biopsy in Endometrial Cancer

NCT ID: NCT04073706

Last Updated: 2025-10-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

760 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-18

Study Completion Date

2031-02-28

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

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.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Hypothesis: The primary hypothesis is that SNB will not cause detriment to patients (lymphoedema, morbidity, loss of quality of life) and not increase costs compared to patients without a retroperitoneal node dissection. The secondary hypothesis is that disease-free survival in patients without retroperitoneal node dissection is not inferior to those receiving SNB.

Aims: To determine the value of SNB for patients, the healthcare system and to exclude detriment to patients.

Objectives:

Primary Stage 1:

To determine the recovery of participants (defined as incidence of adverse events, lower limb lymphoedema and health-related QOL) and to the healthcare system (cost) of Sentinel Node Biopsy (SNB) for the surgical treatment of endometrial cancer.

Primary Stage 2:

Compare disease-free survival at 4.5 years for participants randomised to receive hysterectomy, bilateral salpingo-oophorectomy with SNB compared to participants randomised to hysterectomy, bilateral salpingo-oophorectomy without retroperitoneal node dissection.

Secondary:

* Compare patterns of recurrence and overall survival (OS) between the groups
* Determine the cost-effectiveness of SNB
* Compare Patient Reported Outcomes (PROMS) between the groups at 12 months from surgery
* Compare Health Related Quality of Life (HRQL) and Fear of Recurrence between the groups at 12 months from surgery
* Compare perioperative outcomes (duration of surgery, length of hospital stay, intraoperative blood loss, blood transfusion requirements) and the incidence of intra- and postoperative adverse events within 12 months from surgery between the groups
* Compare lower limb lymphoedema at 12 months after surgery
* Compare the need for postoperative (adjuvant) treatments between groups
* Determine the impact of body composition and frailty on survival, quality of life, lymphoedema, peri-, intra- and postoperative outcomes
* Compare follow-up strategies (clinical vs symptom checklist)
* Translational Research - Trans-ENDO 3 - biobanking strategy - Compare the Molecular profile at 12 months from surgery between the groups

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Endometrial Cancer Stage I Sentinel Lymph Node Surgery

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

TH BSO with SNB

Total Laparoscopic/Robotic Hysterectomy, Bilateral Salpingo-Oophorectomy (TH BSO) with Sentinel Node Biopsy (SNB) using Indocyanine Green (ICG)+/- Methylene Blue Dye (+/- omentectomy in high risk cell types) Note: If participants (≤45 years of age), have Grade 1 endometrial adenocarcinoma (EAC) with myometrial invasion \<50% (by MRI) and wish to retain their ovaries a BSO may be omitted.

Group Type EXPERIMENTAL

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

Intervention Type PROCEDURE

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.

TH BSO without retroperitoneal node dissection

Total Laparoscopic/Robotic Hysterectomy, Bilateral Salpingo-Oophorectomy (TH BSO) without retroperitoneal node dissection (+/- omentectomy in high risk cell types) Note: If participants (≤45 years of age), have Grade 1 endometrial adenocarcinoma (EAC) with myometrial invasion \<50% (by MRI) and wish to retain their ovaries a BSO may be omitted.

Group Type ACTIVE_COMPARATOR

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

Intervention Type PROCEDURE

Removal of uterus, tubes and ovaries without retroperitoneal node dissection

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

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.

Intervention Type 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

Intervention Type PROCEDURE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

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
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

The University of Queensland

OTHER

Sponsor Role collaborator

Queensland Centre for Gynaecological Cancer

OTHER_GOV

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Andreas Obermair, Prof

Role: STUDY_CHAIR

Director, Queensland Centre for Gynaecological Cancer Research

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Houston Methodist Hospital

Houston, Texas, United States

Site Status RECRUITING

Hospital Britanico

Ciudad, Buenos Aires, Argentina

Site Status NOT_YET_RECRUITING

Chris O'Brien Lifehouse

Camperdown, New South Wales, Australia

Site Status RECRUITING

Liverpool Hospital

Liverpool, New South Wales, Australia

Site Status RECRUITING

The Wesley Hospital

Auchenflower, Queensland, Australia

Site Status RECRUITING

Buderim Private Hospital

Buderim, Queensland, Australia

Site Status RECRUITING

North West Private Hospital

Everton Park, Queensland, Australia

Site Status RECRUITING

Royal Brisbane and Women's Hospital

Herston, Queensland, Australia

Site Status RECRUITING

Mater Hospital

South Brisbane, Queensland, Australia

Site Status RECRUITING

Gold Coast University Hospital

Southport, Queensland, Australia

Site Status NOT_YET_RECRUITING

St Andrews War Memorial Hospital

Spring Hill, Queensland, Australia

Site Status RECRUITING

Mercy Hospital for Women

Heidelberg, Victoria, Australia

Site Status RECRUITING

Royal Women's Hospital

Parkville, Victoria, Australia

Site Status RECRUITING

Hospital Municipal Vila Santa Catarina

Santa Catarina, Nelson de Sena, Brazil

Site Status NOT_YET_RECRUITING

Hospital de Base

São José do Rio Preto, São Paulo, Brazil

Site Status NOT_YET_RECRUITING

Fundacao Antonio Prudente, AC Camargo Cancer Center

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Hospital Israelita Albert Einstein

São Paulo, São Paulo, Brazil

Site Status NOT_YET_RECRUITING

Instituto Nacional de Cancerología

Astorga, Medellin, Colombia

Site Status NOT_YET_RECRUITING

Azienda Sanitaria Universitaria Friuli Centrale (ASUFC)

Udine, Via Pozzuolo, Italy

Site Status RECRUITING

National University Hospital and National University Cancer Institute

Singapore, NUH Zone B, Singapore

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

United States Argentina Australia Brazil Colombia Italy Singapore

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Grace Ngiam

Role: CONTACT

+61 7 3346 5590

Sara Baniahmadi

Role: CONTACT

+61733465073

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Jaya Kamath

Role: primary

713-441-6616

Konny Fong

Role: backup

346.238.5815

Julian Di Guilmi, MD

Role: primary

Rhonda Farrell, MD

Role: primary

Sadaf Kalam

Role: backup

Michael Burling, MD

Role: primary

Grace Ngiam

Role: primary

+61 7 3346 5590

Sara Baniahmadi

Role: backup

+61 7 3346 5073

Grace Ngiam

Role: primary

+61 7 3346 5590

Sara Baniahmadi

Role: backup

+61733465073

Grace Ngiam

Role: primary

0733465590

Sara Baniahmadi

Role: backup

+61733465073

Grace Ngiam

Role: primary

+61 7 3346 5590

Sara Baniahmadi

Role: backup

+61733465073

Grace Ngiam

Role: primary

+61 7 3346 5590

Sara Baniahmadi

Role: backup

+61733465073

Grace Ngiam

Role: primary

+61 7 3346 5590

Sara Baniahmadi

Role: backup

+61733465073

Grace Ngiam

Role: primary

+61 7 3346 5590

Sara Baniahmadi

Role: backup

+61733465073

Adam Pendlebury, MD

Role: primary

Estefania Vicario

Role: primary

Orla McNally, MD

Role: backup

Renato Moretti-Marques, MD

Role: primary

Renato

Role: backup

Guilherme Accorsi, MD

Role: primary

Glauco Baiocchi Neto, MD

Role: primary

Bruna Goncalves

Role: backup

Renato Moretti-Marques, MD

Role: primary

Renato

Role: backup

David Viveros, MD

Role: primary

Briegal De Las Calderon

Role: backup

Stefano Restaino, MD

Role: primary

Giuseppe Vizzielli, MD

Role: backup

Joseph Ng Soon Yau, MD

Role: primary

Pearl S Tong, MD

Role: backup

References

Explore related publications, articles, or registry entries linked to this study.

Obermair A, Nicklin J, Gebski V, Hayes SC, Graves N, Mileshkin L, Lin MY, Beale P, Baxter E, Robledo K, Salomon C, Hanna GB, Janda M. A phase III randomized clinical trial comparing sentinel node biopsy with no retroperitoneal node dissection in apparent early-stage endometrial cancer - ENDO-3: ANZGOG trial 1911/2020. Int J Gynecol Cancer. 2021 Dec;31(12):1595-1601. doi: 10.1136/ijgc-2021-003029. Epub 2021 Nov 2.

Reference Type DERIVED
PMID: 34728527 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

ENDO-3

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.