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

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

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