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Recommendations Updated for Radiation Therapy in Endometrial Cancer

Radiation therapy recommended to reduce risk for vaginal and/or pelvic recurrence; data limited for sequencing radiation therapy and chemo

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Dec. 28, 2022 (HealthDay News) — In a clinical practice guideline issued by the American Society for Radiation Oncology and published online Oct. 21 in Practical Radiation Oncology, recommendations are presented for the use of adjuvant radiation therapy (RT) for endometrial cancer.

Matthew M. Harkenrider, M.D., from Loyola University Chicago in Maywood, Illinois, and colleagues reviewed the evidence to update recommendations on the adjuvant management of patients with endometrial cancer.

The authors recommend RT (vaginal brachytherapy or external beam radiation therapy [EBRT]) to reduce the risk for vaginal and/or pelvic recurrence, based on the patient’s clinical-pathologic risk factors. Intensity-modulated radiation therapy with daily image-guided radiation therapy is recommended when EBRT is delivered in order to reduce acute and late toxicity. For patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II with high-risk histologies and for those with FIGO stage III to IV A with any histology, chemotherapy is recommended. There are only limited data and no prospective data to support an optimal sequence when sequencing chemotherapy and RT. For surgical node staging, sentinel lymph node mapping is recommended over pelvic lymphadenectomy; adjuvant therapy use should be based on the pathologic ultrastaging status with isolated tumor cells treated as node-negative and micrometastases treated as node-positive. When making recommendations for adjuvant therapy, the available data on molecular characterization of endometrial cancer is compelling and should increasingly be considered.

“For patients with an elevated risk of recurrence following endometrial cancer surgery, clinical trials consistently show that adjuvant therapy can improve outcomes,” a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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