Knowledge
- The American Society for Radiation Oncology has updated its guidelines for the use of adjuvant therapy in the treatment of patients with endometrial cancer.
Key recommendations
- Adjuvant radiotherapy
- Adjuvant radiotherapy is not recommended in patients with stage IA International Federation of Gynecology and Obstetrics (FIGO) stage 1 or 2 endometrioid cancer without intermediate or high-risk factors.
- Vaginal brachytherapy is recommended for patients without high-risk factors who are either endometrioides FIGO stage IB carcinoma, Grade 1 or 2 or myoinvasive endometrioids-_ Have FIGO stage IA, grade 3 carcinoma.
- External radiotherapy (EBRT) is recommended for patients with endometrioid cancer in FIGO stage IB, grade 3 or FIGO stage II.
- Adjuvant radiotherapy, target volumes, dose fractionation regimens and normal tissue constraints
- For patients undergoing adjuvant EBRT, intensity-modulated radiotherapy (IMRT) is recommended to reduce acute and late toxicity.
- In patients undergoing adjuvant EBRT with IMRT, a target vaginal internal volume is recommended for planning daily image-guided radiotherapy for treatment verification.
- For patients undergoing adjuvant EBRT, a dose of 4,500-5,040 cGy with 180-200 cGy per fraction is recommended.
- Patients undergoing only adjuvant vaginal brachytherapy are recommended treatment of the proximal third to half of the vagina (usually 3-5 cm).
- Systemic therapy
- Systemic therapy is not recommended in patients with endometrioid adenocarcinoma in FIGO stage I-II.
- Adjuvant systemic therapy is recommended for patients with endometrioid carcinoma in FIGO stage III-IVA, regardless of histology.
- Timing of systemic therapy with radiotherapy
- For patients with FIGO stage I-II disease with high-risk histology receiving EBRT and chemotherapy, either sequential or concomitant treatment is recommended.
- Patients receiving vaginal brachytherapy and chemotherapy are recommended for either sequential or concomitant treatment.
- Lymph node assessment
- Bilateral sentinel lymph node mapping is recommended over standard pelvic lymphadenectomy to accurately detect subclinical lymph node metastases, reduce morbidity and facilitate adjuvant therapy choice.
- Adjuvant therapy is recommended for patients who have undergone a hysterectomy and who have been diagnosed with lymph nodes with micro- or macrometastases in the pelvic area (FIGO stage IIIC).
- Molecular testing
- Molecular testing is recommended for patients considering adjuvant therapy.
- Adjuvant radiotherapy is not recommended in patients with stage IA International Federation of Gynecology and Obstetrics (FIGO) stage 1 or 2 endometrioid cancer without intermediate or high-risk factors.
- Vaginal brachytherapy is recommended for patients without high-risk factors who are either endometrioides FIGO stage IB carcinoma, Grade 1 or 2 or myoinvasive endometrioids-_ Have FIGO stage IA, grade 3 carcinoma.
- External radiotherapy (EBRT) is recommended for patients with endometrioid cancer in FIGO stage IB, grade 3 or FIGO stage II.
- For patients undergoing adjuvant EBRT, intensity-modulated radiotherapy (IMRT) is recommended to reduce acute and late toxicity.
- In patients undergoing adjuvant EBRT with IMRT, a target vaginal internal volume is recommended for planning daily image-guided radiotherapy for treatment verification.
- For patients undergoing adjuvant EBRT, a dose of 4,500-5,040 cGy with 180-200 cGy per fraction is recommended.
- Patients undergoing only adjuvant vaginal brachytherapy are recommended treatment of the proximal third to half of the vagina (usually 3-5 cm).
- Systemic therapy is not recommended in patients with endometrioid adenocarcinoma in FIGO stage I-II.
- Adjuvant systemic therapy is recommended for patients with endometrioid carcinoma in FIGO stage III-IVA, regardless of histology.
- For patients with FIGO stage I-II disease with high-risk histology receiving EBRT and chemotherapy, either sequential or concomitant treatment is recommended.
- Patients receiving vaginal brachytherapy and chemotherapy are recommended for either sequential or concomitant treatment.
- Bilateral sentinel lymph node mapping is recommended over standard pelvic lymphadenectomy to accurately detect subclinical lymph node metastases, reduce morbidity and facilitate adjuvant therapy choice.
- Adjuvant therapy is recommended for patients who have undergone a hysterectomy and who have been diagnosed with lymph nodes with micro- or macrometastases in the pelvic area (FIGO stage IIIC).
- Molecular testing is recommended for patients considering adjuvant therapy.
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Source — https://www.univadis.de/viewarticle/endometriumkarzinom-aktualisierte-leitlinien-zur-strahlentherapie
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