Regular Article
Radiation therapy in endometrial cancer

https://doi.org/10.1053/beog.2001.0186Get rights and content

Abstract

The role of radiation in endometrial cancer, especially in the adjuvant setting, is controversial. Factors that influence radiotherapy recommendations include surgical considerations, pathological findings, potential sites of disease recurrence and the practice philosophies of the individual physician. It has been demonstrated that adjuvant radiotherapy following primary surgery significantly improves pelvic tumour control, but has no measurable impact on overall survival in an unselected patient population. Studies to date have been hampered by the inclusion of patients with a wide spectrum of prognostic features; this may decrease the likelihood of observing greater benefit in discriminate subsets at higher risk of relapse. Further trials are required to define clinical prognosis more precisely and to investigate the role of radiation in higher-risk patients. In the meantime, we propose guidelines for radiotherapy in endometrial cancer which serve as bases for discussion and collaboration among physicians and as platforms for future study and progress.

References (58)

  • M Chadha et al.

    Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy

    Gynecologic Oncology

    (1999)
  • I Ackerman et al.

    Endometrial carcinoma—relative effectiveness of adjuvant irradiation vs therapy reserved for relapse

    Gynecologic Oncology

    (1996)
  • MS Carey et al.

    Good outcome associated with a standardized treatment protocol using selective postoperative radiation in patients with clinical stage I adenocarcinoma of the endometrium

    Gynecologic Oncology

    (1995)
  • E Podczaski et al.

    Detection and patterns of treatment failure in 300 consecutive cases of ‘early’ endometrial cancer after primary surgery

    Gynecologic Oncology

    (1992)
  • DM Larson et al.

    Surgery without radiotherapy for primary treatment of endometrial cancer

    Obstetrics and Gynecology

    (1998)
  • CL Creutzberg et al.

    Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma

    Lancet

    (2000)
  • H Kucera et al.

    Benefit of external irradiation in pathologic stage I endometrial carcinoma: a prospective clinical trial of 605 patients who received postoperative vaginal irradiation and additional pelvic irradiation in the presence of unfavorable prognostic factors

    Gynecologic Oncology

    (1990)
  • O Algan et al.

    Improved outcome in patients treated with postoperative radiation therapy for pathologic stage I/II endometrial cancer

    International Journal of Radiation Oncology, Biology, Physics

    (1996)
  • C Irwin et al.

    The role of adjuvant radiotherapy in carcinoma of the endometrium—results in 550 patients with pathologic stage I disease

    Gynecologic Oncology

    (1998)
  • KM Greven et al.

    Which prognostic factors influence the outcome of patients with surgically staged endometrial cancer treated with adjuvant radiation?

    International Journal of Radiation Oncology, Biology, Physics

    (1997)
  • GH Eltabbakh et al.

    Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial

    International Journal of Radiation Oncology, Biology, Physics

    (1997)
  • JM Anderson et al.

    High-dose-rate postoperative vaginal cuff irradiation alone for stage IB and IC endometrial cancer

    International Journal of Radiation Oncology, Biology, Physics

    (2000)
  • E Weiss et al.

    Adjuvant vaginal high-dose-rate afterloading alone in endometrial carcinoma: patterns of relapse and side effects following low-dose therapy

    Gynecologic Oncology

    (1998)
  • C MacLeod et al.

    High-dose-rate brachytherapy alone post-hysterectomy for endometrial cancer

    International Journal of Radiation Oncology, Biology, Physics

    (1998)
  • H Cardenes et al.

    Clarity and confusion regarding adjuvant radiation therapy in early endometrial cancer

    Gynecologic Oncology

    (1999)
  • RW Naumann et al.

    The use of adjuvant radiation therapy by members of the Society of Gynecologic Oncologists

    Gynecologic Oncology

    (1999)
  • RA Potish et al.

    Role of whole abdominal radiation therapy in the management of endometrial cancer; prognostic importance of factors indicating peritoneal metastases

    Gynecologic Oncology

    (1985)
  • N Kadar et al.

    Positive peritoneal cytology is an adverse factor in endometrial carcinoma only if there is other evidence of extrauterine disease

    Gynecologic Oncology

    (1992)
  • Cited by (18)

    • Survival outcome in endometrial cancer patients according to hereditary predisposition

      2015, Taiwanese Journal of Obstetrics and Gynecology
      Citation Excerpt :

      All patients underwent total hysterectomy and pelvic lymph node dissection, with or without para-aortic lymph node dissection. Adjuvant pelvic radiation after complete surgical staging was performed in patients with potential adverse risk factors such as age, grade, lymphovascular invasion, tumor size, lower uterine involvement, and outer-third myometrial invasion [11–13]. Adjuvant chemotherapy was performed in patients with Stage IVb disease or concurrent ovarian cancer.

    • Endometrial Cancer

      2015, Clinical Radiation Oncology
    • Endometrial Cancer

      2012, Clinical Radiation Oncology: Third Edition
    • Endometrial Cancer

      2011, Clinical Radiation Oncology, Third Edition
    • Lymphovascular space invasion does not predict vaginal relapses in stage I endometrioid adenocarcinoma of the endometrium

      2008, Annals of Diagnostic Pathology
      Citation Excerpt :

      The reported salvage rates for these patients have been variable, ranging from 67% to 89% in 3 major reports [31,33,34]. Although the use of adjuvant radiotherapy (high and/or low dose vaginal cuff brachytherapy and/or external beam radiotherapy) in reducing the locoregional relapse rates for stage 1 endometrial cancers has been noted in several reports [22-24,27-32], there continues to be a lack ofconsensus among clinical practitioners with respect to which group of patients is best suited to receive adjuvantradiotherapy [35,36]. This lack of consensus is most glaring for surgically staged FIGO stage 1B endometrioid adenocarcinoma, grades 1 and 2, in which some practitioners advocate no postoperative radiotherapy; whereas others advocate vaginal cuff brachytherapy [35,36].

    View all citing articles on Scopus
    f1

    To whom correspondence should be addressed.

    View full text