Endometrial cancer is primarily treated with surgery [total hysterectomy with bilateral salpingo-oophorectomy (BSO)] with or without nodal assessment (sentinel lymph node biopsy or nodal dissection). Adjuvant radiation therapy is considered based on pathological findings that impact risk of recurrence, including stage, grade, depth of myometrial invasion, presence of lymphovascular space invasion, and nodal involvement. Vaginal cuff brachytherapy (VBT) is increasingly being used to treat high-intermediate-risk early-stage endometrial cancer due to efficacy in reducing vaginal cuff recurrence and improved toxicity profile compared to pelvic EBRT. Similarly, in medically inoperable low-risk early-stage disease, brachytherapy with or without EBRT or hormone therapy is recommended. Advanced-stage endometrial cancer is often treated with multimodality treatment including chemotherapy, EBRT, brachytherapy, and surgery. In this chapter, we review the role of hypofractionated RT in endometrial cancer, particularly in the setting of HDR-VBT.
KeywordsEndometrium Endometrial cancer Vaginal brachytherapy Intracavitary brachytherapy Interstitial brachytherapy High-dose rate (HDR)
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