The use of adjuvant radiation therapy in the treatment of endometrial cancer is detailed in a new guideline issued by the American Society of Radiation Oncology (ASTRO). The guideline clarifies the role of radiation therapy in treating endometrial cancer, which has been inconsistent due to different interpretations of various trials.
The guidelines were published in Practical Radiation Oncology (2014; doi:10.1016/j.prro.2014.01.003). The panel that wrote the guidelines included 17 leading gynecologic specialists who compiled and reviewed extensive data from 330 studies.
The data population selected for the guideline was defined as women of all races, age 18 years or older, with stage I-IV endometrial cancer of any histologic type or grade. The studies included patients who underwent a hysterectomy followed by no adjuvant therapy, or pelvic and/or vaginal brachytherapy with or without systemic chemotherapy. The panel identified five key questions about the role of adjuvant radiation therapy and developed a series of recommendations to address each question.
The five questions addressed were which patients with endometrioid endometrial cancer require no additional therapy after hysterectomy, which patients with endometrioid endometrial cancer should receive vaginal cuff radiation, which women should receive postoperative external beam radiation, when should brachytherapy be used in addition to external beam radiation, and how radiation therapy and chemotherapy should be integrated in the management of endometrial cancer.
“Several trials on the role of radiation therapy in endometrial cancer have been reported in the past 5 years, seeking to clarify this topic; however, these trials have been interpreted in different ways, leading to inconsistent treatment recommendations,” said Ann Klopp, MD, PhD, and Akila N. Viswanathan, MD, MPH, co-chairs of the ASTRO Endometrial Guideline Panel. “This guideline provides recommendations to help ensure patients receive the best possible care and to help patients and doctors make informed decisions about treatment options.”