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Endometrial Cancer

  • Brittaney-Belle E. Gordon
  • Orit Kaidar-Person
  • Mahesh Varia
  • Ashley A. Weiner
Chapter

Abstract

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.

Keywords

Endometrium Endometrial cancer Vaginal brachytherapy Intracavitary brachytherapy Interstitial brachytherapy High-dose rate (HDR) 

References

  1. 1.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60:2035–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Schink JC, Rademaker AW, Miller DS, Lurain JR. Tumor size in endometrial cancer. Cancer. 1991;67(11):2791–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Cohn DE, Horowitz NS, Mutch DG, Kim SM, Manolitsas T, Fowler JM. Should the presence of lymphovascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? Gynecol Oncol. 2002;87(3):243–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012;104(21):1625–34.  https://doi.org/10.1093/jnci/djs374.CrossRefPubMedGoogle Scholar
  5. 5.
    Schwarz JK, Beriwal S, Esthappan J, et al. Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer. Brachytherapy. 2015;14:587–99.  https://doi.org/10.1016/j.brachy.2015.06.002.CrossRefPubMedGoogle Scholar
  6. 6.
    Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer. 2016;26:2–30.  https://doi.org/10.1097/IGC.0000000000000609.CrossRefPubMedGoogle Scholar
  7. 7.
    Higginson DS, Morris DE, Jones EL, Clarke-Pearson D, Varia MA. Stereotactic body radiotherapy (SBRT): technological innovation and application in gynecologic oncology. Gynecol Oncol. 2011;120:404–12.  https://doi.org/10.1016/j.ygyno.2010.11.042.CrossRefPubMedGoogle Scholar
  8. 8.
    Kunos CA, Brindle J, Waggoner S, et al. Phase II clinical trial of robotic stereotactic body radiosurgery for metastatic gynecologic malignancies. Front Oncol. 2012;2:181.  https://doi.org/10.3389/fonc.2012.00181.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:744–51.  https://doi.org/10.1016/j.ygyno.2003.11.048.CrossRefPubMedGoogle Scholar
  10. 10.
    Baek S, Isohashi F, Yamaguchi H, et al. Salvage high-dose-rate brachytherapy for isolated vaginal recurrence of endometrial cancer. Brachytherapy. 2016;15(6):812–6.  https://doi.org/10.1016/j.brachy.2016.08.005.CrossRefPubMedGoogle Scholar
  11. 11.
    Small W, Beriwal S, Demanes DJ, et al. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012;11(1):58–67.  https://doi.org/10.1016/j.brachy.2011.08.005.CrossRefPubMedGoogle Scholar
  12. 12.
    Jhingran A, Burke TW, Eifel PJ. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys. 2003;56(5):1366–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Lin LL, Grigsby PW, Powell MA, Mutch DG. Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. Int J Radiat Oncol. 2005;63(2):500–4.  https://doi.org/10.1016/j.ijrobp.2005.02.004.CrossRefGoogle Scholar
  14. 14.
    Wahl AO, Gaffney DK, Jhingran A, et al. ACR appropriateness criteria® adjuvant management of early-stage endometrial cancer. Oncology (Williston Park). 2016;30(9):816–22.Google Scholar
  15. 15.
    Harkenrider MM, Grover S, Erickson BA, et al. Vaginal brachytherapy for postoperative endometrial cancer: 2014 Survey of the American Brachytherapy Society. Brachytherapy. 2016;15:23–9.  https://doi.org/10.1016/j.brachy.2015.09.012.CrossRefPubMedGoogle Scholar
  16. 16.
    Alektiar KM, Venkatraman E, Chi DS, Barakat RR. Intravaginal brachytherapy alone for intermediate-risk endometrial cancer. Int J Radiat Oncol Biol Phys. 2005;62:111–7.  https://doi.org/10.1016/j.ijrobp.2004.09.054.CrossRefPubMedGoogle Scholar
  17. 17.
    Onsrud M, Cvancarova M, Hellebust TP, Tropé CG, Kristensen GB, Lindemann K. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(31):3951–6.  https://doi.org/10.1200/JCO.2013.48.8023.CrossRefGoogle Scholar
  18. 18.
    Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol. 1980;56(4):419–27.PubMedGoogle Scholar
  19. 19.
    Sorbe B, Horvath G, Andersson H, Boman K, Lundgren C, Pettersson B. External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma--a prospective randomized study. Int J Radiat Oncol Biol Phys. 2012;82(3):1249–55.  https://doi.org/10.1016/j.ijrobp.2011.04.014.CrossRefPubMedGoogle Scholar
  20. 20.
    Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375:816–23.  https://doi.org/10.1016/S0140-6736(09)62163-2.CrossRefPubMedGoogle Scholar
  21. 21.
    Sorbe BG, Smeds AC. Postoperative vaginal irradiation with high dose rate afterloading technique in endometrial carcinoma stage I. Int J Radiat Oncol Biol Phys. 1990;18(2):305–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Weiss E, Hirnle P, Arnold-Bofinger H, Hess CF, Bamberg M. Adjuvant vaginal high-dose-rate afterloading alone in endometrial carcinoma: patterns of relapse and side effects following low-dose therapy. Gynecol Oncol. 1998;71(1):72–6.  https://doi.org/10.1006/gyno.1998.5155.CrossRefPubMedGoogle Scholar
  23. 23.
    Petereit DG, Tannehill SP, Grosen EA, Hartenbach EM, Schink JC. Outpatient vaginal cuff brachytherapy for endometrial cancer. Int J Gynecol Cancer. 1999;9(6):456–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Horowitz NS, Peters WA, Smith MR, Drescher CW, Atwood M, Mate TP. Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma. Obstet Gynecol. 2002;99(2):235–40.PubMedGoogle Scholar
  25. 25.
    Diavolitsis V, Rademaker A, Lurain J, Hoekstra A, Strauss J, Small W. Clinical outcomes in international federation of gynecology and obstetrics stage IA endometrial cancer with myometrial invasion treated with or without postoperative vaginal brachytherapy. Int J Radiat Oncol Biol Phys. 2012;84(2):415–9.  https://doi.org/10.1016/j.ijrobp.2011.12.010.CrossRefPubMedGoogle Scholar
  26. 26.
    Lybeert ML, van Putten WL, Ribot JG, Crommelin MA. Endometrial carcinoma: high dose-rate brachytherapy in combination with external irradiation; a multivariate analysis of relapses. Radiother Oncol. 1989;16(4):245–52.CrossRefPubMedGoogle Scholar
  27. 27.
    Nori D, Merimsky O, Batata M, Caputo T. Postoperative high dose-rate intravaginal brachytherapy combined with external irradiation for early stage endometrial cancer: a long-term follow-up. Int J Radiat Oncol Biol Phys. 1994;30(4):831–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Algan O, Tabesh T, Hanlon A, Hogan WM, Boente M, Lanciano RM. Improved outcome in patients treated with postoperative radiation therapy for pathologic stage I/II endometrial cancer. Int J Radiat Oncol Biol Phys. 1996;35(5):925–33.CrossRefPubMedGoogle Scholar
  29. 29.
    Cannon GM, Geye H, Terakedis BE, et al. Outcomes following surgery and adjuvant radiation in stage II endometrial adenocarcinoma. Gynecol Oncol. 2009;113(2):176–80.  https://doi.org/10.1016/j.ygyno.2008.12.029.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Brittaney-Belle E. Gordon
    • 1
  • Orit Kaidar-Person
    • 2
    • 3
  • Mahesh Varia
    • 1
  • Ashley A. Weiner
    • 1
  1. 1.University of North Carolina School of MedicineChapel HillUSA
  2. 2.Department of Radiation OncologyUniversity of North Carolina School of MedicineChapel HillUSA
  3. 3.Oncology Institute Radiation Oncology and Neuro-Oncology UnitRambam Medical CenterHaifaIsrael

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