New Guidelines on Radiation Therapy After Surgery for Endometrial Cancer

The American Society of Clinical Oncology (ASCO) today issued an endorsement of the American Society for Radiation Oncology (ASTRO) clinical practice guideline on postoperative radiation therapy for women with endometrial (uterine) cancer.

The endorsement outlines treatments that ASTRO and ASCO agree should be the standard of care for women with endometrial cancer, based on the best available evidence. It also underscores areas where more research is needed to determine how women should be treated.

“Despite the fact that endometrial cancer is the most common gynecologic cancer in the United States, there is a lot of controversy about how best to treat it,” said Larissa A. Meyer, MD, MPH, F.A.C.O.G., co-chair of ASCO’s Expert Panel that endorsed the guideline. “We hope that this endorsement will help standardize treatments, so that all women receive the best care possible.”

Prior research has shown that there are widespread variations in endometrial cancer care. In fact, patients often receive different treatments in different parts of the country. The ASTRO guideline provides clear information about how and when to use radiation therapy after surgery.

“The goal of this guideline is to reduce unnecessary and potentially harmful treatment of women who are at low risk for developing recurrent cancers, while increasing the use of combined radiation and chemotherapy in women who are at high risk for recurrence and therefore need treatment,” said Alexi A. Wright, MD, MPH, co-chair of ASCO’s Expert Panel that endorsed the guideline. “We need to improve outcomes for women with endometrial cancer.”

The ASCO Expert Panel determined that the recommendations from the ASTRO guideline were clear, thorough, and based on the most relevant scientific evidence.

Key guideline recommendations:

  • For women who have undergone a total abdominal hysterectomy with or without lymph node dissection, it is reasonable to avoid radiation therapy if women have grade 1 or 2 cancers with either no invasion or <50% invasion of the myometrium.
  • Vaginal cuff brachytherapy is as effective as pelvic radiation at preventing vaginal recurrence for patients with (1) grade 1 or 2 tumors with > 50% myometrial invasion or (2) grade 3 tumors with <50% myometrial invasion.
  • The best available evidence at this time suggests that reasonable options for adjuvant treatment of patients with positive nodes, or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder, or rectum includes external beam radiation therapy, as well as adjuvant chemotherapy.

Increasing numbers of women of child-bearing age are being diagnosed with endometrial cancer in the United States. This trend is attributed to the growing prevalence of obesity and diabetes. This trend, coupled with the trend of delaying of child-bearing, has led to an increased focus on options that may preserve ovarian function or fertility. Cancer treatments, including radiation, chemotherapy, and surgery, can lead to loss of fertility. ASCO’s endorsement includes consideration of the effects of cancer treatment on fertility, which was not addressed in the original guideline.

The endorsement, Postoperative Radiation Therapy for Endometrial Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology (ASTRO) Evidence-Based Guideline was published in the Journal of Clinical Oncology.

Source: ASCO Press Release.

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