The role of adjuvant radiation in endometrial cancer.
Endometrial cancer treatment ideally begins with a staging procedure including abdominopelvic washing, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node evaluation. Recommendations for postoperative adjuvant radiotherapy are determined by recurrence risk. Patients who have undergone staging and have early stage I disease and an absence of high-risk features for recurrence generally are treated with surgery alone. Intermediate-risk patients--those with high-risk stage I disease and some stage II patients--may benefit from adjuvant radiation therapy. Several randomized trials show that radiation therapy improves locoregional control among intermediate-risk patients. The optimal type of radiation therapy, whether vaginal brachytherapy or whole-pelvic radiation therapy, remains undetermined, though treatment decision can be guided by risk factors not encompassed by the current staging system. Patients with high-risk stage II disease and stage III disease generally receive external-beam radiotherapy, often in combination with chemotherapy. Chemotherapy alone in advanced-stage patients is a consideration, given the results of the Gynecologic Oncology Group (GOG)-122 trial.
Diavolitsis
Virginia
V
Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA.
Boyle
John
J
Singh
Diljeet K
DK
Small
William
W
D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009367:Neoplasm Staging; D010052:Ovariectomy; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012008:Recurrence; D018570:Risk Assessment; D016896:Treatment Outcome