The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline.
OBJECTIVE
To present evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer.


METHODS
Key clinical questions to be addressed in this evidence-based guideline on endometrial cancer were identified. A comprehensive literature review was performed to identify studies that included no adjuvant therapy, or pelvic radiation or vaginal brachytherapy with or without systemic chemotherapy. Outcomes included local control, survival rates, and overall assessment of quality of life.


RESULTS
Patients with grade 1 or 2 cancers with either no invasion or <50% myometrial invasion (MI), especially when no other high risk features are present, can be safely observed after hysterectomy. Vaginal cuff brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence for patients with grade 1 or 2 cancers with ≥50% MI or grade 3 tumors with <50% MI. Patients with grade 3 cancer with ≥50% MI or cervical stroma invasion may benefit from pelvic radiation to reduce the risk of pelvic recurrence. There is limited evidence for a benefit to vaginal cuff brachytherapy following pelvic radiation. Multimodality treatment is recommended for patients with positive nodes or involved uterine serosa, ovaries or fallopian tubes, vagina, bladder, or rectum.


CONCLUSIONS
External beam and vaginal brachytherapy remain integral aspects of adjuvant therapy for endometrial cancer.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Ann
A
Klopp
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Benjamin D
BD
Smith
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Kaled
K
Alektiar
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Alvin
A
Cabrera
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Antonio L
AL
Damato
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Beth
B
Erickson
Department of Medicine, University of Chicago, Chicago, Illinois.
Gini
G
Fleming
Department of Radiation Oncology, University of Utah, Salt Lake, Utah.
David
D
Gaffney
Department of Radiation Oncology, Wake Forest University, Winston-Salem, North Carolina.
Kathryn
K
Greven
Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Karen
K
Lu
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
David
D
Miller
Franciscan Alliance, Mishawaka, Indiana.
David
D
Moore
Regional Cancer Care Institute, Rapid City, South Dakota.
Daniel
D
Petereit
Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado.
Tracey
T
Schefter
Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago, Illinois.
William
W
Small
Department of Radiation Oncology, University of California San Diego, San Diego, California.
Catheryn
C
Yashar
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: aviswanathan@lroc.harvard.edu.
Akila N
AN
Viswanathan
D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D011184:Postoperative Period; D011788:Quality of Life; D018787:Radiation Oncology / Q000592:standards*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant