Radiation Oncology/Endometrium/Guidelines

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Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

Endometrial Carcinoma: Main Page | Staging | Overview | Early Stage | Locally Advanced Stage | UPSC | Clear Cell | Brachytherapy | Recurrence | Randomized | GOG Trials

Leiomyosarcoma: Main Page


Endometrial Cancer Guidelines


  • SFGO: Societe Francaise d'Oncologie Gynecologique
    • 2011 PMID 21697683 -- "Clinical practice guidelines for the management of patients with endometrial cancer in france: recommendations of the Institut National du Cancer and the Société Française d'Oncologie Gynécologique" (Querleu D, Int J Gynecol Cancer. 2011 Jul;21(5):945-50.)
  • Stage I - Low risk (IAG1-G2)
    • Surgery: TH/BSO, PLND not recommended
    • RT: HDR VB if myometrial invasion; EBRT not recommended
    • Chemo: not recommended
  • Stage I - Intermediate risk (IAG3, IBG1-G2)
    • Surgery: TH/BSO, PLND not recommended but can be considered IBG2 or IAG3 with myometrial involvement
    • RT: HDR VB; EBRT not recommended
    • Chemo: not recommended
  • Stage I - High risk (IBG3, IA-B type 2, I with LVI+)
    • Surgery: TH/BSO, P/PALND recommended
    • RT: pelvic EBRT; additional VBT can be considered
    • Chemo: not recommended
  • Stage I - Clear cell or papillary serous
    • Surgery: TH/BSO, P/PALND, infracolic omentectomy, periotoneal cytology, biopsy
    • RT: pelvic EBRT; additional VBT can be considered
    • Chemo: can be considered
  • Stage I - Carcinosarcoma
    • Surgery: TH/BSO, P/PALND
    • RT: pelvic EBRT; additional VBT can be considered
    • Chemo: can be considered
  • Stage II
    • Surgery: Hysterectomy, +/- vaginectomy, PLND,
      • For type I: consider PLND
      • For type II: P/PALND, infracolic omentectomy, peritoneal cytology, biopsy
    • RT: EBRT with HDR VBT; if large volume cervix disease, can consider preop RT
    • Chemo: Can be considered for type 2
  • Stage IIIA
    • Surgery: TH/BSO, infragastric omentectomy, P/PALND, peritoneal cytology
    • RT
      • Serosa alone: pelvic EBT with HDR VBT
      • Cervix affected: HDR VBT
    • Chemo: if adnexa affected
  • Stage IIIB
    • RT as sole therapy is the main option (pelvic EBRT with uterine/vaginal BT)
    • PLND as staging can be considered
    • Chemo: concomitant chemotherapy can be considered
    • Surgery: can be considered if partial response to RT
  • Stage IIIC (pathologic)
    • Surgery: immediate or delayed PALND
    • RT: pelvic RT (IIIC1) or pelvic/para-aortic RT (IIIC2) with HDR VBT
    • Chemo: adjuvant CT must be discussed
  • Stage IIIC1 (imaging)
    • Surgery: TH/BSO, PPALND
    • RT: pelvic EBRT, with VBT
    • Chemo: adjuvant CT may be discussed
  • Stage IIIC2 (imaging)
    • Pelvic and para-aortic RT, followed by lymphatic boost, and uterine/vaginal BT
    • If conditions favorable for surgery, TH/BSO and PPALND recommended, followed by pelvic EBRT and VBT
    • Chemo: must be discussed
  • Stage IV (Bowel/bladder)
    • Pelvic EBRT with BT
    • Chemo: can be considered
    • If RT fails, pelvic exenteration can be considered
  • Stage IV (Distant mets, including intra-abdominal or inguinal nodes)
    • Cytoreductive surgery only for operable peritoneal carcinosis
    • Chemo: recommended
    • Hormone therapy: recommended for ER+
    • RT: pelvic EBRT recommended to primary tumor
    • If inguinal LN, additional lymphadenectomy recommended

Brachytherapy

  • ABS: American Brachytherapy Society
    • 2012: Vaginal cuff PMID 22265439 -- "American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy."
      • Note: also includes indications for vaginal cuff irradiation for cervical cancer