Navigation Links
ASTRO issues guideline on the role of postoperative radiation therapy for endometrial cancer
Date:4/23/2014

Fairfax, Va., April 23, 2014 The American Society for Radiation Oncology (ASTRO) has issued a new guideline, "The Role of Postoperative Radiation Therapy for Endometrial Cancer: An ASTRO Evidence-Based Guideline," that details the use of adjuvant radiation therapy in the treatment of endometrial cancer. The guideline's executive summary is published in the May-June 2014 issue of Practical Radiation Oncology (PRO), the official clinical practice journal of ASTRO. The full-length guideline is available as an open-access article online at http://www.practicalradonc.org.

ASTRO's Guidelines Panel of 17 leading gynecologic specialists compiled and reviewed extensive data from 330 studies from MEDLINE, EMBASE and the Specialized Register of the Cochrane Gynaecological Cancer Review Group published from 1980 to 2011. The data population selected for the guideline was defined as women of all races, age 18 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 first Key Question addresses which patients with endometrioid endometrial cancer require no additional therapy after hysterectomy. For patients with no residual disease in the hysterectomy specimen despite positive biopsy or grade 1 or 2 cancers with either no invasion or <50 percent myometrial invasion, especially when no other high-risk features are present, no adjuvant radiation therapy is a reasonable option. Patients with grade 3 cancers without myometrial invasion or grade 1 or 2 cancers with <50 percent myometrial invasion and higher risk factors such as age >60 and/or lymphovascular space invasion could reasonably be treated with or without vaginal cuff brachytherapy.

Key Question 2 examines which patients with endometrioid endometrial cancer should receive vaginal cuff radiation. Evidence demonstrates that cuff brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence for patients with 1) grade 1 or 2 cancers with ≥50 percent myometrial invasion or 2) grade 3 tumors with <50 percent myometrial invasion. Vaginal cuff brachytherapy is preferred to pelvic radiation in patients with these risk factors particularly in patients who have had comprehensive nodal assessment.

Key Question 3 details which women should receive postoperative external beam radiation. Patients with early stage endometrial cancer which is grade 3 with ≥50 percent myometrial invasion or cervical stroma invasion are felt to benefit from pelvic radiation to reduce the risk of pelvic recurrence. Patients with grade 1 or 2 tumors with ≥50 percent myometrial invasion may also benefit from pelvic radiation to reduce pelvic recurrence rates if other risk factors are presents such as age >60 years and/or lymphovascular space invasion. For patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder or rectum, the best available evidence suggests that treatment should include external beam radiation therapy as well as adjuvant chemotherapy. Chemotherapy or radiation therapy alone may be considered for some patients based on pathologic risk factors for pelvic recurrence.

Key Question 4 addresses when brachytherapy should be used in addition to external beam radiation. The panel noted that data is lacking to validate the use of brachytherapy after pelvic radiation and that retrospective studies show little conclusive evidence of a benefit, albeit with small patient numbers. Use of vaginal brachytherapy in patients also undergoing pelvic external beam radiation may not generally be warranted, unless risk factors for vaginal recurrence are present.

Key Question 5 examines how radiation therapy and chemotherapy should be integrated in the management of endometrial cancer. The panel concluded that the best available evidence suggests that concurrent chemoradiation followed by adjuvant chemotherapy is indicated for patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder or rectum. Alternative sequencing strategies with external beam radiation and chemotherapy are also acceptable. Chemotherapy or radiation therapy alone may be considered for some patients based on pathologic risk factors for pelvic recurrence.

"Several trials on the role of radiation therapy in endometrial cancer have been reported in the past five 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."

The guideline was approved by ASTRO's Board of Directors in September 2013 and is endorsed by the Society of Gynecologic Oncology. The guideline panel members included radiation oncologists, gynecologic oncologists, medical oncologists, a resident in radiation oncology and radiation physicists: Dr. Klopp (co-chair), Dr. Viswanathan (co-chair), Benjamin D. Smith, MD, Kaled Alektiar, MD, Alvin Cabrera, MD, Antonio L. Damato, PhD, Beth Erickson, MD, FASTRO, Gini Fleming, MD, David Gaffney, MD, PhD, Kathryn Greven, MD, FASTRO, Karen Lu, MD, David Miller, MD, David Moore, MD, Daniel Petereit, MD, Tracey Schefter, MD, William Small Jr., MD, FASTRO, and Catheryn Yashar, MD.


'/>"/>

Contact: Michelle Kirkwood
michellek@astro.org
703-286-1600
American Society for Radiation Oncology
Source:Eurekalert

Related medicine news :

1. Some astronauts at risk for cognitive impairment, animal studies suggest
2. Extreme energy efficiency, hot astrophysics, nuclear medicine and more at the 2014 APS April Meeting
3. Researchers develop device that simulates gastro-intestinal tract
4. Study finds astronauts hearts become more spherical in space
5. ASTRO and SSO issue consensus guideline on margins for breast-conserving surgery with WBI
6. New research on diverticular disease in the December issue of Clinical Gastroenterology and Hepatology
7. It’s a Bird, It’s a Plane, It’s a… Buddhist Monk? Crowd Gathers in the Castro for “The Temple” Book Launch
8. MEDIVATORS Inc. and Edison Nation Medical Search for New Medical Invention Ideas to Improve Detection of Lower Gastrointestinal Diseases; Search Concludes Jan. 20, 2014
9. Scientists show how cells protect their DNA from catastrophic damage
10. Gastrointestinal Bleeding Market: Global Clinical Trials Review H2 2013 in New Research Report at RnRMarketResearch.com
11. gGastro Receives ONC-ACB Certification by Drummond Group
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... 2016 , ... The temporary closing of Bruton Memorial Library on June 21 due to a ... new, often overlooked aspect of head lice: the parasite’s ability to live away from a ... occurrence, but a necessary one in the event that lice have simply gotten out of ...
(Date:6/25/2016)... City, Oklahoma (PRWEB) , ... June 25, 2016 ... ... helping both athletes and non-athletes recover from injury. Recently, he has implemented orthobiologic ... the Oklahoma City area —Johnson is one of the first doctors to perform ...
(Date:6/24/2016)... ... June 24, 2016 , ... Those who have experienced traumatic ... many turn to unhealthy avenues, such as drug or alcohol abuse, as a coping ... released tools for healthy coping following a traumatic event. , Trauma sufferers tend to ...
(Date:6/24/2016)... ... , ... Global law firm Greenberg Traurig, P.A. announced that 20 Florida attorneys ... peers for this recognition are considered among the top 2 percent of lawyers practicing ... members of this year’s Legal Elite Hall of Fame: Miami Shareholders Mark D. ...
(Date:6/24/2016)... ... 24, 2016 , ... People across the U.S. are sharpening their pencils and ... essay contest in which patients and their families pay tribute to a genetic counselor ... National Society of Genetic Counselors (NSGC) Annual Education Conference (AEC) this September. , ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 Research and Markets ... Market by Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic ... Coating, Parenteral) - Global Forecast to 2021" report ... The global pharmaceutical excipients market is projected to ... of 6.1% in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... Capricor Therapeutics, Inc. ... company focused on the discovery, development and commercialization ... in its ongoing randomized HOPE-Duchenne clinical trial (Halt ... its 24-patient target. Capricor expects the trial to ... 2016, and to report top line data from ...
(Date:6/23/2016)... RIDGE, Ill. and INDIANAPOLIS ... of students receiving a Lilly Diabetes Tomorrow,s Leaders Scholarship ... The 2016 scholarship winners, announced today online at ... to let type 1 diabetes stand in the way ... Diabetes has supported the Foundation,s scholarship program since 2012, ...
Breaking Medicine Technology: