Radiation Oncology/Endometrium/Guidelines
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Front Page: Radiation Oncology | RTOG Trials | Randomized Trials |
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Endometrial Carcinoma: Main Page | Staging | Overview | Early Stage | Locally Advanced Stage | UPSC | Clear Cell | Brachytherapy | Recurrence | Randomized | GOG Trials | |
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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
- Surgery: Hysterectomy, +/- vaginectomy, PLND,
- 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
- 2012: Vaginal cuff PMID 22265439 -- "American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy."