title: Adjuvant treatment for endometrial cancer: literature review and recommendations by the Comité de l'évolution des pratiques en oncologie (CEPO).
abstract: OBJECTIVE
  Despite the very good prognosis of endometrial cancer, a number of patients with localized disease relapse following surgery. Therefore, various adjuvant therapeutic approaches have been studied. The objective of this review is to evaluate the efficacy and safety of neoadjuvant and adjuvant therapies in patients with resectable endometrial cancer and to develop evidence-based recommendations.
  
  
  METHODS
  A review of the scientific literature published between January 1990 and June 2012 was performed. The search was limited to published phase III clinical trials and meta-analyses evaluating the efficacy of neoadjuvant or adjuvant therapies in patients with endometrial carcinoma or carcinosarcoma. A total of 23 studies and five meta-analyses were identified.
  
  
  RESULTS
  The selected literature showed that in patients with a low risk of recurrence, post-surgical observation is safe and recommended in most cases. There are several therapeutic modalities available for treatment of endometrial cancers with higher risk of recurrence, including vaginal brachytherapy, external beam radiotherapy, chemotherapy, or a combination of these.
  
  
  CONCLUSIONS
  Considering the evidence available to date, the CEPO recommends the following: (1)post-surgical observation for most patients with a low recurrence risk; (2)adjuvant vaginal brachytherapy for patients with an intermediate recurrence risk; (3)adjuvant pelvic radiotherapy with or without vaginal brachytherapy for patients with a high recurrence risk; addition of adjuvant chemotherapy may be considered as an option for selected patients (excellent functional status, no significant co-morbidities, poor prognostic factors); (4)adjuvant chemotherapy and pelvic radiotherapy with or without brachytherapy and para-aortic irradiation for patients with advanced disease;
authors.affiliation: Direction québécoise de cancérologie, Ministère de la Santé et des Services sociaux du Québec (MSSS), Québec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Morneau
authors.forename: William
authors.initials: W
authors.lastname: Foster
authors.forename: Marc
authors.initials: M
authors.lastname: Lalancette
authors.forename: Thu
authors.initials: T
authors.lastname: Van Nguyen-Huynh
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Renaud
authors.forename: Vanessa
authors.initials: V
authors.lastname: Samouëlian
authors.forename: Nathalie
authors.initials: N
authors.lastname: Letarte
authors.forename: Karine
authors.initials: K
authors.lastname: Almanric
authors.forename: Gino
authors.initials: G
authors.lastname: Boily
authors.forename: Philippe
authors.initials: P
authors.lastname: Bouchard
authors.forename: Jim
authors.initials: J
authors.lastname: Boulanger
authors.forename: Ghislain
authors.initials: G
authors.lastname: Cournoyer
authors.forename: Félix
authors.initials: F
authors.lastname: Couture
authors.forename: Normand
authors.initials: N
authors.lastname: Gervais
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Goulet
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Guay
authors.forename: Mélanie
authors.initials: M
authors.lastname: Kavanagh
authors.forename: Julie
authors.initials: J
authors.lastname: Lemieux
authors.forename: Bernard
authors.initials: B
authors.lastname: Lespérance
authors.forename: Nathalie
authors.initials: N
authors.lastname: Letarte
authors.forename: Mélanie
authors.initials: M
authors.lastname: Morneau
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ouellet
authors.forename: Gilles
authors.initials: G
authors.lastname: Pineau
authors.forename: Raghu
authors.initials: R
authors.lastname: Rajan
authors.forename: Isabelle
authors.initials: I
authors.lastname: Roy
authors.forename: Benoît
authors.initials: B
authors.lastname: Samson
authors.forename: Lucas
authors.initials: L
authors.lastname: Sidéris
authors.forename: François
authors.initials: F
authors.lastname: Vincent
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D001918:Brachytherapy; D002296:Carcinosarcoma / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant
chemical_list: D006728:Hormones
keywords: Adjuvant; Cancer; Chemotherapy; Endometrium; Radiotherapy