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Uterine Cancer pp 261-273 | Cite as

Adjuvant Radiation in Early-Stage Endometrial Cancer: Evidence, Principles, and Techniques

  • Umesh Mahantshetty
  • Shirley Christabel
  • Reena Engineer
  • Supriya Chopra
  • Shyamkishore Shrivastava

Abstract

Endometrial cancer is a common gynecological cancer and is mainly seen in postmenopausal women. Sixty-seven to seventy-three percent of patients have stage I–II disease [4, 5]. The purpose of this chapter is to discuss various factors associated with endometrial cancers which are vital for treatment decisions and provide guide for appropriate adjuvant radiation in early endometrial cancers. Adjuvant radiation therapy plays an important role in improving locoregional control rates.

Keywords

Endometrial Cancer Pelvic Radiation Surgical Staging Myometrial Invasion Endometrial Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Platanoitis G, Castiglione M. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Supplement 5):v41–5.CrossRefGoogle Scholar
  2. 2.
    Morneau M, Foster W, Lalancette M, Van Nguyen-Huynh T, Renaud MC, Samouelian V, et al. Adjuvant treatment for endometrial cancer: literature review and recommendations by the Comite de l’evolution des pratiques en oncologie (CEPO). Gynecol Oncol. 2013;131(1):231–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Sushama S, Rasika B, Mahantshetty U. Hospital-based study of endometrial cancer survival. Asia Pac J Cancer Prev. 2013;14(2):977–80.CrossRefGoogle Scholar
  4. 4.
    Yoney A, Yildirim C, Bati Y, Unsal M. Low risk stage I endometrial carcinoma: prognostic factors and outcomes. Indian J Cancer. 2011;48(2):204–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Mahantshetty U, Aggarwal A, Ganesh B, Saoba S, Mulla S, Engineer R, et al. Clinical outcome of early-stage endometrioid adenocarcinoma: a tertiary cancer center experience. Int J Gynecol Cancer. 2013;23(8):1446–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Kitchener H, Swart AM, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373(9658):125–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. Lancet. 2000;355(9213):1404–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Creasman WT, Morrow P, Bundy B, Homesley H. Surgical pathologic spread patterns of endometrial cancer. Cancer. 1987;60:2035–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Kupets R, Le T, Bentley J, Farrell S, Fortier MP, Giede C, et al. The role of adjuvant therapy in endometrial cancer. J Obstet Gynaecol Can. 2013;35(4):375–9.PubMedGoogle Scholar
  11. 11.
    Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(3):744–51.CrossRefPubMedGoogle Scholar
  12. 12.
    Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma. Obstet Gynecol. 1980;56(4):419–27.PubMedGoogle Scholar
  13. 13.
    Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89(2):201–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Nout RA, van de Poll-Franse LV, Lybeert MLM, Wárlám-Rodenhuis CC, Jobsen JJ, Mens JWM, et al. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the postoperative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011;29(13):1692–700.CrossRefPubMedGoogle Scholar
  15. 15.
    Blake P, Swart AM, Orton J, Kitchener H, Whelan T, Lukka H, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373(9658):137–46.CrossRefPubMedGoogle Scholar
  16. 16.
    Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012;104(21):1625–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Nout RA, Smit VTHBM, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375(9717):816–23.CrossRefPubMedGoogle Scholar
  18. 18.
    Sorbe B, Horvath G, Andersson H, Boman K, Lundgren C, Pettersson B. External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma – a prospective randomized study. Int J Radiat Oncol Biol Phys. 2012;82(3):1249–55.CrossRefPubMedGoogle Scholar
  19. 19.
    Sorbe B, Nordström B, Mäenpää J, Kuhelj J, Kuhelj D, Okkan S, et al. Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer. 2009;19(5):873–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Reed NS, Mangioni C, Malmstrom H, Scarfone G, Poveda A, Picorelli S. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer. 2008;44(6):808–18.CrossRefPubMedGoogle Scholar
  21. 21.
    Galaal K, Van Der Heijden E, Godfrey K, Naik R, Kucukmetin A, Bryant A, et al. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma (review). Cochrane Database Syst Rev. 2013;2:CD006812.PubMedGoogle Scholar
  22. 22.
    Ly D, Rowley BD, Dodson MK, Soisson PA, Jolles CJ, Gaffney DK, et al. Adjuvant radiation in early stage, unfavorable histology endometrial carcinoma is associated with improved local control and survival. Gynecol Oncol. 2014;133(2):250–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Kong A, Powell M, Blake P. The role of postoperative radiotherapy in carcinoma of the endometrium. Clin Oncol (R Coll Radiol (Great Britain)). 2008;20(6):457–62.CrossRefGoogle Scholar
  24. 24.
    Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al. The morbidity of treatment for patients with stage I endometrial cancer: results from a randomized trial. Int J Radiat Oncol Biol Phys. 2001;51(5):1246–55.CrossRefPubMedGoogle Scholar
  25. 25.
    Nout RA, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, van der Steen-Banasik EM, et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009;27(21):3547–56.CrossRefPubMedGoogle Scholar
  26. 26.
    Hogberg T, Signorelli M, De Oliveira CF, Fossati R, Lissoni AA, Sorbe B, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer-results from two randomised studies. Eur J Cancer. 2010;46(13):2422–31.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Mundt AJ, Lujan AE, Rotmensch J, Waggoner SE, Yamada SD, Fleming G, et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;52(5):1330–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Brixey CJ, Roeske JC, Lujan AE, Yamada SD, Rotmensch J, Mundt AJ. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;54(5):1388–96.CrossRefPubMedGoogle Scholar
  29. 29.
    Mundt AJ, Mell LK, Roeske JC. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56(5):1354–60.CrossRefPubMedGoogle Scholar
  30. 30.
    Small W, Mell LK, Anderson P, Creutzberg C, De Los Santos J, Gaffney D, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71(2):428–34.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Shih KK, Milgrom SA, Abu-Rustum NR, Kollmeier MA, Gardner GJ, Tew WP, et al. Postoperative pelvic intensity-modulated radiotherapy in high risk endometrial cancer. Gynecol Oncol. 2013;128(3):535–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Jhingran A, Winter K, Portelance L, Miller B, Salehpour M, Gaur R, et al. A phase II study of intensity modulated radiation therapy to the pelvis for postoperative patients with endometrial carcinoma: radiation therapy oncology group trial 0418. Int J Radiat Oncol Biol Phys. 2012;84(1):e23–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Small W, Beriwal S, Demanes DJ, Dusenbery KE, Eifel P, Erickson B, et al. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012;11(1):58–67.CrossRefPubMedGoogle Scholar
  34. 34.
    Straughn JM, Huh WK, Kelly FJ, Leath CA, Kleinberg MJ, Hyde J, et al. Conservative management of stage I endometrial carcinoma after surgical staging. Gynecol Oncol. 2002;84(2):194–200.CrossRefPubMedGoogle Scholar
  35. 35.
    Dowdy SC. Improving oncologic outcomes for women with endometrial cancer: realigning our sights. Gynecol Oncol. 2014;133(2):370–4.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Viani GA, Patia BF, Pellizzon AC, De Melo MD, Novaes PE, Fogaroli RC, et al. High-risk surgical stage 1 endometrial cancer: analysis of treatment outcome. Radiat Oncol. 2006;1:24.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Reddoch JM, Burke TW, Morris M, Tornos C, Levenback C, Gershenson DM. Surveillance for recurrent endometrial carcinoma: development of a follow-up scheme. Gynecol Oncol. 1995;59(2):221–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  • Umesh Mahantshetty
    • 1
  • Shirley Christabel
    • 1
  • Reena Engineer
    • 1
  • Supriya Chopra
    • 1
  • Shyamkishore Shrivastava
    • 1
  1. 1.Department of Radiation OncologyTata Memorial CentreMumbaiIndia

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