Technical Aspects of Radiation Therapy in Endometrial Carcinoma

  • Higinia R. Cárdenes
  • David L. Andolino
  • Jennifer E. Zook
Part of the Medical Radiology book series (MEDRAD)


An estimated 43,470 new cases of EC are expected in the US in 2010 with 7,950 estimated deaths (American Cancer Society Cancer facts and figures 2010. American Cancer Society, Atlanta, 2010). Currently, EC is the fourth most common cancer in females, ranking behind breast, bowel, and lung cancer. In over 80% of the cases, the disease is confined to the uterus and cervix at the time of diagnosis, and uncorrected survival rates of 75% or greater are expected (Pecorelli Int J Gynaecol Obstet 105(2):103–104, 2009). In the last 25 years, the treatment of EC has evolved from almost routine use of preoperative radiotherapy (RT), generally intracavitary brachytherapy, followed by hysterectomy, to upfront surgical staging followed by tailored adjuvant therapy based on histopathological findings, as recommended by the International Federation of Gynecology and Obstetrics (FIGO Int J Gynecol Obstet 28:189–193, 1989). The purpose of this chapter is to review the role and technical aspects of external beam RT (EBRT) and brachytherapy in the management of EC as well as describing the radiotherapeutic approach as definitive therapy for medically inoperable patients and in the salvage setting for recurrent disease.


Endometrial Cancer Intensity Modulate Radiation Therapy Surgical Staging Myometrial Invasion Deep Myometrial Invasion 
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  1. Aalders J, Abeler V, Kolstad P, Onsrud M (1980) Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol 56(4):419–427PubMedGoogle Scholar
  2. Ahamad A, D’Souza W, Salehpour M, Iyer R, Tucker SL, Jhingran A, Eifel PJ (2005) Intensity-modulated radiation therapy after hysterectomy: comparison with conventional treatment and sensitivity of the normal-tissue-sparing effect to margin size. Int J Radiat Oncol Biol Phys 62(4):1117–1124PubMedCrossRefGoogle Scholar
  3. Alektiar KM, Venkatraman E, Chi DS, Barakat RR (2005) Intravaginal brachytherapy alone for intermediate-risk endometrial cancer. Int J Radiat Oncol Biol Phys 62(1):111–117PubMedCrossRefGoogle Scholar
  4. American Cancer Society (2010) Cancer facts and figures 2010. American Cancer Society, AtlantaGoogle Scholar
  5. Ashman JB, Connell PP, Yamada D, Rotmensch J, Waggoner SE, Mundt AJ (2001) Outcome of endometrial carcinoma patients with involvement of the uterine serosa. Gynecol Oncol 82(2):338–343PubMedCrossRefGoogle Scholar
  6. ASTEC Study Group, Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125–136 [Erratum appears in Lancet. 23;373(9677):1764]PubMedCrossRefGoogle Scholar
  7. Axelrod J, Bundy B, Roy T, King M, Sutton G, Rosenshein N (1995) Advanced endometrial carcionoma treated with whole abdominal irradiation: a GOG study (abstract). Gynecol Oncol 56(1):135–136Google Scholar
  8. Barakat RR, Goldman NA, Patel DA, Venkatraman ES, Curtin JP (1999) Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol 75(1):99–102PubMedCrossRefGoogle Scholar
  9. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Croce C, Mangioni C (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100(23):1707–1716PubMedCrossRefGoogle Scholar
  10. Beriwal S, Kim H, Heron DE, Selvaraj R (2006) Comparison of 2D vs. 3D dosimetry for Rotte ‘Y’ applicator high dose rate brachytherapy for medically inoperable endometrial cancer. Tech Canc Res Treat 5(5):521–527Google Scholar
  11. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, Blessing JA (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63(6):825–832PubMedGoogle Scholar
  12. Boye E, Lindegaard MW, Paus E, Skretting A, Davy M, Jakobsen E (1984) Whole-body distribution of radioactivity after intraperitoneal administration of 32P colloids. Br J Radiol 57(677):395–402PubMedCrossRefGoogle Scholar
  13. Brixey CJ, Roeske JC, Lujan AE, Yamada SD, Rotmensch J, Mundt AJ (2002) Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 54(5):1388–1396PubMedCrossRefGoogle Scholar
  14. Chao CK, Grigsby PW, Perez CA, Mutch DG, Herzog T, Camel HM (1996) Medically inoperable stage I endometrial carcinoma: a few dilemmas in radiotherapeutic management. Int J Radiat Oncol Biol Phys 34(1):27–31PubMedCrossRefGoogle Scholar
  15. Chen LM, McGonigle KF, Berek JS (1999) Endometrial cancer: recent developments in evaluation and treatment. Oncology 13(12):1665–1670; discussion 1675–1668, 1681–1662PubMedGoogle Scholar
  16. Chung HH, Kang S-B, Cho JY, Kim JW, Park N-H, Song Y-S, Kim SH, Lee H-P (2007) Can preoperative MRI accurately evaluate nodal and parametrial invasion in early stage cervical cancer? Jpn J Clin Oncol 37(5):370–375PubMedCrossRefGoogle Scholar
  17. Connell PP, Rotmensch J, Waggoner S, Mundt AJ (1999) The significance of adnexal involvement in endometrial carcinoma. Gynecol Oncol 74(1):74–79PubMedCrossRefGoogle Scholar
  18. Craighead PS, Sait K, Stuart GC, Arthur K, Nation J, Duggan M, Guo D (2000) Management of aggressive histologic variants of endometrial carcinoma at the Tom Baker Cancer Centre between 1984 and 1994. Gynecol Oncol 77(2):248–253PubMedCrossRefGoogle Scholar
  19. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A gynecologic oncology group study. Cancer 60(Suppl 8):2035–2041PubMedCrossRefGoogle Scholar
  20. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, De Winter KA, Lutgens LC, van den Bergh AC, van de Steen-Banasik E, Beerman H, van Lent M (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC study group. Post operative radiation therapy in endometrial carcinoma. Lancet 355(9213):1404–1411PubMedCrossRefGoogle Scholar
  21. Creutzberg CL, van Putten WLJ, Koper PC, Lybeert MLM, Jobsen JJ, Warlam-Rodenhuis CC, De Winter KAJ, Lutgens LCHW, van den Bergh ACM, van der Steen-Banasik E, Beerman H, van Lent M, Group PS (2003) Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 89(2):201–209PubMedCrossRefGoogle Scholar
  22. Creutzberg CL, van Putten WLJ, Warlam-Rodenhuis CC, van den Bergh ACM, de Winter KAJ, Koper PCM, Lybeert MLM, Slot A, Lutgens LCHW, Stenfert Kroese MC, Beerman H, van Lent M (2004) Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the postoperative radiation therapy in endometrial carcinoma trial. J Clin Oncol 22(7):1234–1241PubMedCrossRefGoogle Scholar
  23. Currie JL, Bagne F, Harris C, Sullivan DL, Surwit EA, Wilkinson RH Jr, Creasman WT (1981) Radioactive chromic phosphate suspension: studies on distribution, dose absorption, and effective therapeutic radiation in phantoms, dogs, and patients. Gynecol Oncol 12(2 Pt 1):193–218PubMedCrossRefGoogle Scholar
  24. DelMaschio A, Vanzulli A, Sironi S, Spagnolo D, Belloni C, Garancini P, Taccagni GL (1993) Estimating the depth of myometrial involvement by endometrial carcinoma: efficacy of transvaginal sonography vs MR imaging. AJR Am J Roentgenol 160(3):533–538PubMedGoogle Scholar
  25. Disaia PJ, Syed N, Puthwala AA (1990) Malignant neoplasia of the upper vagina. Endocurietherapy/Hyperthermia Oncol 6:251–256Google Scholar
  26. Fakiris AJ, Moore DH, Reddy SR, Look KY, Yiannoutsos CT, Randall ME, Cardenes HR, Hoosier Oncology G (2005) Intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy as adjuvant treatment for uterine papillary serous carcinoma and clear cell carcinoma: a phase II Hoosier Oncology Group (HOG 97–01) study. Gynecol Oncol 96(3):818–823PubMedCrossRefGoogle Scholar
  27. Fakiris AJ, Henderson M, Lo SS, Look KY, Cardenes HR (2010) Intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy as adjuvant treatment for uterine papillary serous carcinoma and clear cell carcinoma: the Indiana University experience. Brachytherapy 9(1):61–65PubMedCrossRefGoogle Scholar
  28. Fields AL, Einstein MH, Novetsky AP, Gebb J, Goldberg GL (2008) Pilot phase II trial of radiation “sandwiched” between combination paclitaxel/platinum chemotherapy in patients with uterine papillary serous carcinoma (UPSC). Gynecol Oncol 108(1):201–206PubMedCrossRefGoogle Scholar
  29. FIGO (1971) Classification and staging of malignant tumors in the female pelvis. Int J Gynecol Obstet 9:172Google Scholar
  30. FIGO (1989) Corpus cancer staging. Int J Gynecol Obstet 28:189–193CrossRefGoogle Scholar
  31. Fishman DA, Roberts KB, Chambers JT, Kohorn EI, Schwartz PE, Chambers SK (1996) Radiation therapy as exclusive treatment for medically inoperable patients with stage I and II endometrioid carcinoma with endometrium. Gynecol Oncol 61(2):189–196PubMedCrossRefGoogle Scholar
  32. Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T (2006) Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol 103(1):155–159PubMedCrossRefGoogle Scholar
  33. Grigsby PW, Kuske RR, Perez CA, Walz BJ, Camel MH, Kao MS, Galakatos A (1987) Medically inoperable stage I adenocarcinoma of the endometrium treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 13(4):483–488PubMedCrossRefGoogle Scholar
  34. Grigsby PW, Perez CA, Kuten A, Simpson JR, Garcia DM, Camel HM, Kao MS, Galakatos AE (1992) Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system. Int J Radiat Oncol Biol Phys 22(5):905–911PubMedCrossRefGoogle Scholar
  35. Hasbini A, Haie-Meder C, Morice P, Chirat E, Duvillard P, Lhommé C, Delapierre M, Gerbaulet A (2002) Outcome after salvage radiotherapy (brachytherapy ± external) in patients with a vaginal recurrence from endometrial carcinomas. Radiother Oncol 65(1):23–28PubMedCrossRefGoogle Scholar
  36. Hogberg T, Signorelli M, de Freire Oliveiro C, Fossati R, Alberto Lissoni A, Sorbe B, Andersson H, Grenman S, Lundgren C, Rosenberg P, Boman K, Tholander B, Scambia G, Reed N, Cormio G, Tognon G, Clarke J, Sawicki T, Zola P, Kristensen G (2010) Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer–results from two randomised studies. Eur J Cancer 46(13):2422–2431PubMedCrossRefGoogle Scholar
  37. Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, Spirtos NM, Morris RT, DeGeest K, Lee R, Montag A (2009) A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a gynecologic oncology group study. Gynecol Oncol 112(3):543–552PubMedCrossRefGoogle Scholar
  38. Horowitz NS, Dehdashti F, Herzog TJ, Rader JS, Powell MA, Gibb RK, Grigsby PW, Siegel BA, Mutch DG (2004) Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol 95(3):546–551PubMedCrossRefGoogle Scholar
  39. Hsieh C-H, ChangChien C-C, Lin H, Huang E-Y, Huang C-C, Lan K-C, Chang S-Y (2002) Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer? Gynecol Oncol 86(1):28–33PubMedCrossRefGoogle Scholar
  40. Huh WK, Powell M, Leath CA 3rd, Straughn JM Jr, Cohn DE, Gold MA, Falkner CA, Carey DE, Herzog T, Fowler JM, Partridge EE, Kilgore LC, Alvarez RD (2003) Uterine papillary serous carcinoma: comparisons of outcomes in surgical stage I patients with and without adjuvant therapy. Gynecol Oncol 91(3):470–475PubMedCrossRefGoogle Scholar
  41. Jhingran A, Burke TW, Eifel PJ (2003) Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys 56(5):1366–1372PubMedCrossRefGoogle Scholar
  42. Kelly MG, O’Malley D, Hui P, McAlpine J, Dziura J, Rutherford TJ, Azodi M, Chambers SK, Schwartz PE (2004) Patients with uterine papillary serous cancers may benefit from adjuvant platinum-based chemoradiation. Gynecol Oncol 95(3):469–473PubMedCrossRefGoogle Scholar
  43. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, Pearlman A, Maiman MA, Bell JG (2004) Gynecologic Oncology G 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 92(3):744–751 [Erratum appears in Gynecol Oncol. 2004 Jul;94(1):241-2]PubMedCrossRefGoogle Scholar
  44. Kim SH, Kim HD, Song YS, Kang SB, Lee HP (1995) Detection of deep myometrial invasion in endometrial carcinoma: comparison of transvaginal ultrasound, CT, and MRI. J Comput Assist Tomogr 19(5):766–772PubMedCrossRefGoogle Scholar
  45. Kitajima K, Murakami K, Yamasaki E, Fukasawa I, Inaba N, Kaji Y, Sugimura K (2008) Accuracy of 18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol 190(6):1652–1658PubMedCrossRefGoogle Scholar
  46. Kupelian PA, Eifel PJ, Tornos C, Burke TW, Delclos L, Oswald MJ (1993) Treatment of endometrial carcinoma with radiation therapy alone. Int J Radiat Oncol Biol Phys 27(4):817–824PubMedCrossRefGoogle Scholar
  47. Kwon JS, Abrams J, Sugimoto A, Carey MS (2008) Is adjuvant therapy necessary for stage IA and IB uterine papillary serous carcinoma and clear cell carcinoma after surgical staging? Int J Gynecol Canc 18(4):820–824CrossRefGoogle Scholar
  48. Larson DM, Johnson KK, Broste SK, Krawisz BR, Kresl JJ (1995) Comparison of D and C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol 86(1):38–42PubMedCrossRefGoogle Scholar
  49. Lian J, Mackenzie M, Joseph K, Pervez N, Dundas G, Urtasun R, Pearcey R (2008) Assessment of extended-field radiotherapy for stage iiic endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy. Int J Radiat Oncol Biol Phys 70(3):935–943. doi: 10.1016/j.ijrobp.2007.10.021 PubMedCrossRefGoogle Scholar
  50. Lim P, Al Kushi A, Gilks B, Wong F, Aquino-Parsons C (2001) Early stage uterine papillary serous carcinoma of the endometrium: effect of adjuvant whole abdominal radiotherapy and pathologic parameters on outcome. Cancer 91(4):752–757PubMedCrossRefGoogle Scholar
  51. Lin LL, Grigsby PW, Powell MA, Mutch DG (2005) Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. Int J Radiat Oncol Biol Phys 63(2):500–504PubMedCrossRefGoogle Scholar
  52. Lujan AE, Mundt AJ, Yamada SD, Rotmensch J, Roeske JC (2003) Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys 57(2):516–521PubMedCrossRefGoogle Scholar
  53. Lupe K, D’Souza DP, Kwon JS, Radwan JS, Harle IA, Hammond JA, Carey MS (2009) Adjuvant carboplatin and paclitaxel chemotherapy interposed with involved field radiation for advanced endometrial cancer. Gynecol Oncol 114(1):94–98PubMedCrossRefGoogle Scholar
  54. Maggi R, Lissoni A, Spina F, Melpignano M, Zola P, Favalli G, Colombo A, Fossati R (2006) Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer 95(3):266–271PubMedCrossRefGoogle Scholar
  55. Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC (2000) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 182(6):1506–1519PubMedCrossRefGoogle Scholar
  56. Mariani A, Webb MJ, Keeney GL, Haddock MG, Aletti G, Podratz KC (2002) Stage IIIC endometrioid corpus cancer includes distinct subgroups. Gynecol Oncol 87(1):112–117PubMedCrossRefGoogle Scholar
  57. Martinez AA, Weiner S, Podratz K, Armin AR, Stromberg JS, Stanhope R, Sherman A, Schray M, Brabbins DA (2003) Improved outcome at 10 years for serous-papillary/clear cell or high-risk endometrial cancer patients treated by adjuvant high-dose whole abdomino-pelvic irradiation. Gynecol Oncol 90(3):537–546PubMedCrossRefGoogle Scholar
  58. Mehta N, Yamada SD, Rotmensch J, Mundt AJ (2003) Outcome and pattern of failure in pathologic stage I–II papillary serous carcinoma of the endometrium: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys 57(4):1004–1009PubMedCrossRefGoogle Scholar
  59. Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE (1991) Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a gynecologic oncology group study. Gynecol Oncol 40(1):55–65PubMedCrossRefGoogle Scholar
  60. Mundt AJ, Mell LK, Roeske JC (2003) Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 56(5):1354–1360PubMedCrossRefGoogle Scholar
  61. Nag S, Erickson B, Parikh S, Gupta N, Varia M, Glasgow G (2000) The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the endometrium. Int J Radiat Oncol Biol Phys 48(3):779–790PubMedCrossRefGoogle Scholar
  62. National Cancer Data Base (2004)
  63. Nelson G, Randall M, Sutton G, Moore D, Hurteau J, Look K (1999) FIGO stage IIIC endometrial carcinoma with metastases confined to pelvic lymph nodes: analysis of treatment outcomes, prognostic variables, and failure patterns following adjuvant radiation therapy. Gynecol Oncol 75(2):211–214PubMedCrossRefGoogle Scholar
  64. Nout RA, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, van der Steen-Banasik EM, Mens JWM, Slot A, Stenfert Kroese MC, van Bunningen BNFM, Smit VTHBM, Nijman HW, van den Tol PP, Creutzberg CL (2009) Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol 27(21):3547–3556PubMedCrossRefGoogle Scholar
  65. Nout RA, Smit VTHBM, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, van der Steen-Banasik EM, Mens JWM, Slot A, Kroese MCS, van Bunningen BNFM, Ansink AC, van Putten WLJ, Creutzberg CL, PORTEC Study Group (2010) 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 375(9717):816–823PubMedCrossRefGoogle Scholar
  66. Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105(2):103–104PubMedCrossRefGoogle Scholar
  67. Petereit DG, Sarkaria JN, Chappell RJ (1998) Perioperative morbidity and mortality of high-dose-rate gynecologic brachytherapy. Int J Radiat Oncol Biol Phys 42(5):1025–1031PubMedCrossRefGoogle Scholar
  68. Petignat P, Jolicoeur M, Alobaid A, Drouin P, Gauthier P, Provencher D, Donath D, Van Nguyen T (2006) Salvage treatment with high-dose-rate brachytherapy for isolated vaginal endometrial cancer recurrence. Gynecol Oncol 101(3):445–449PubMedCrossRefGoogle Scholar
  69. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, Thigpen JT, Benda JA (2006) Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol 24(1):36–44PubMedCrossRefGoogle Scholar
  70. Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, Jacobs I, Reznek RH (2007) Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Canc 17(1):188–196CrossRefGoogle Scholar
  71. Salama JK, Mundt AJ, Roeske J, Mehta N (2006) Preliminary outcome and toxicity report of extended-field, intensity-modulated radiation therapy for gynecologic malignancies. Int J Radiat Oncol Biol Phys 65(4):1170–1176. doi: 10.1016/j.ijrobp.2006.02.041 PubMedCrossRefGoogle Scholar
  72. Savelli L, Ceccarini M, Ludovisi M, Fruscella E, De Iaco PA, Salizzoni E, Mabrouk M, Manfredi R, Testa AC, Ferrandina G (2008) Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol 31(5):560–566PubMedCrossRefGoogle Scholar
  73. Scholten AN, van Putten WLJ, Beerman H, Smit VTHBM, Koper PCM, Lybeert MLM, Jobsen JJ, Warlam-Rodenhuis CC, De Winter KAJ, Lutgens LCHW, van Lent M, Creutzberg CL, Group PS (2005) Postoperative radiotherapy for stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys 63(3):834–838PubMedCrossRefGoogle Scholar
  74. Schorge JO, Hossein Saboorian M, Hynan L, Ashfaq R (2002) ThinPrep detection of cervical and endometrial adenocarcinoma: a retrospective cohort study. Cancer 96(6):338–343PubMedCrossRefGoogle Scholar
  75. Silverberg SG, Kurman RJ (1992) Tumors of the uterine corpus and gestational trophoblastic disease, vol 3. Armed Forces Institute of Pathology, WashingtonGoogle Scholar
  76. Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW (2010) Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 60(2):99–119PubMedCrossRefGoogle Scholar
  77. Spanos W Jr, Guse C, Perez C, Grigsby P, Doggett RL, Poulter C (1989) Phase II study of multiple daily fractionations in the palliation of advanced pelvic malignancies: preliminary report of RTOG 8502. Int J Radiat Oncol Biol Phys 17(3):659–661PubMedCrossRefGoogle Scholar
  78. Spanos WJ, Perez CA Jr, Marcus S, Poulter CA, Doggett RL, Steinfeld AD, Grigsby PW (1993) Effect of rest interval on tumor and normal tissue response—a report of phase III study of accelerated split course palliative radiation for advanced pelvic malignancies (RTOG-8502). Int J Radiat Oncol Biol Phys 25(3):399–403PubMedCrossRefGoogle Scholar
  79. Spanos WJ Jr, Clery M, Perez CA, Grigsby PW, Doggett RL, Poulter CA, Steinfeld AD (1994) Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502). Int J Radiat Oncol Biol Phys 29(5):961–967PubMedCrossRefGoogle Scholar
  80. Straughn JM Jr, Huh WK, Kelly FJ, Leath CA 3rd, Kleinberg MJ, Hyde J Jr, Numnum TM, Zhang Y, Soong S-J, Austin JM Jr, Partridge EE, Kilgore LC, Alvarez RD (2002) Conservative management of stage I endometrial carcinoma after surgical staging. Gynecol Oncol 84(2):194–200PubMedCrossRefGoogle Scholar
  81. Susumu N, Sagae S, Udagawa Y, Niwa K, Kuramoto H, Satoh S, Kudo R (2008) Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: a Japanese gynecologic oncology group study. Gynecol Oncol 108(1):226–233. doi: 10.1016/j.ygyno.2007.09.029 PubMedCrossRefGoogle Scholar
  82. Sutton G, Axelrod JH, Bundy BN, Roy T, Homesley HD, Malfetano JH, Mychalczak BR, King ME (2005) Whole abdominal radiotherapy in the adjuvant treatment of patients with stage III and IV endometrial cancer: a gynecologic oncology group study. Gynecol Oncol 97(3):755–763PubMedCrossRefGoogle Scholar
  83. Sutton G, Axelrod JH, Bundy BN, Roy T, Homesley HD, Lee RB, Gehrig PA, Zaino R (2006) Adjuvant whole abdominal irradiation in clinical stages I and II papillary serous or clear cell carcinoma of the endometrium: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol 100(2):349–354PubMedCrossRefGoogle Scholar
  84. Suzuki R, Miyagi E, Takahashi N, Sukegawa A, Suzuki A, Koike I, Sugiura K, Okamoto N, Inoue T, Hirahara F (2007) Validity of positron emission tomography using fluoro-2-deoxyglucose for the preoperative evaluation of endometrial cancer. Int J Gyncol Canc 17(4):890–896CrossRefGoogle Scholar
  85. Taghian A, Pernot M, Hoffstetter S, Luporsi E, Bey P (1988) Radiation therapy alone for medically inoperable patients with adenocarcinoma of the endometrium. Int J Radiat Oncol Biol Phys 15(5):1135–1140PubMedCrossRefGoogle Scholar
  86. Torricelli P, Ferraresi S, Fiocchi F, Ligabue G, Jasonni VM, Di Monte I, Rivasi F (2008) 3-T MRI in the preoperative evaluation of depth of myometrial infiltration in endometrial cancer. AJR Am J Roentgenol 190(2):489–495PubMedCrossRefGoogle Scholar
  87. Turner BC, Knisely JP, Kacinski BM, Haffty BG, Gumbs AA, Roberts KB, Frank AH, Peschel RE, Rutherford TJ, Edraki B, Kohorn EI, Chambers SK, Schwartz PE, Wilson LD (1998) Effective treatment of stage I uterine papillary serous carcinoma with high dose-rate vaginal apex radiation (192Ir) and chemotherapy. Int J Radiat Oncol Biol Phys 40(1):77–84PubMedCrossRefGoogle Scholar
  88. Wong E, D’Souza DP, Chen JZ, Lock M, Rodrigues G, Coad T, Trenka K, Mulligan M, Bauman GS, Bauman GS (2005) Intensity-modulated arc therapy for treatment of high-risk endometrial malignancies. Int J Radiat Oncol Biol Phys 61(3):830–841PubMedCrossRefGoogle Scholar
  89. Yahata T, Aoki Y, Tanaka K (2007) Prediction of myometrial invasion in patients with endometrial carcinoma: comparison of magnetic resonance imaging, transvaginal ultrasonography, and gross visual inspection. Eur J Gynaecol Oncol 28(3):193–195PubMedGoogle Scholar
  90. Young RC, Walton LA, Ellenberg SS, Homesley HD, Wilbanks GD, Decker DG, Miller A, Park R, Major F, Jr (1990) Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials. N Engl J Med 322(15):1021–1027PubMedCrossRefGoogle Scholar
  91. Zaino RJ, Kurman RJ, Diana KL, Morrow CP (1996) Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage, clinical stage—a gynecologic oncology group study. Cancer 77(6):1115–1121 [Erratum appears in Cancer 1997 Jan 15;79(2):422]PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Higinia R. Cárdenes
    • 1
  • David L. Andolino
    • 1
  • Jennifer E. Zook
    • 1
  1. 1.Department of Radiation OncologyIndiana University School of MedicineIndianapolisUSA

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