Skip to main content

Endometrial Cancer

  • Chapter
  • First Online:

Abstract

This chapter will discuss the epidemiology, workup, staging, treatment recommendations, key studies, and radiation treatment techniques for endometrial cancer.

This is a preview of subscription content, log in via an institution.

References

  • Aalders JG, Abeler V, Kolstad P, et al. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Gynecol Oncol. 1980;56:419.

    CAS  Google Scholar 

  • Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I. Clinical management of uterine sarcomas. Lancet Oncol. 2009;10(12):1188–98.

    Article  Google Scholar 

  • ASTEC study group, Kitchener H, Swart AM, et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomized study. Lancet. 2009;373:125–36.

    Article  Google Scholar 

  • ASTEC/EN.5 study group, Blake P, Swart AM, Orton J, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373:137–46.

    Article  Google Scholar 

  • Barillot I, Tavernier E, Peignaux K, et al. Impact of post operative intensity modulated radiotherapy on acute gastro-intestinal toxicity for patients with endometrial cancer: results of the phase II RTCMIENDOMETRE French multicentre trial. Radiother Oncol. 2014;111(1):138–43.

    Article  Google Scholar 

  • de Boer SM, Powell ME, Mileshkin L, et al. Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(8):1114–26.

    Article  Google Scholar 

  • Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15(1):10–7.

    Article  CAS  Google Scholar 

  • Bonadona V, Bonaïti B, Olschwang S, et al. Cancer risks associated with germline mutations in MLH1, MSH2, and MSH6 genes in lynch syndrome. JAMA. 2011;305(22):2304–10.

    Article  CAS  Google Scholar 

  • Brinton LA, Felix AS, McMeekin DS, et al. Etiologic heterogeneity in endometrial cancer: evidence from a gynecologic oncology group trial. Gynecol Oncol. 2013;129(2):277–84.

    Article  Google Scholar 

  • Cancer Genome Atlas Research Network, et al. Integrated genomic characterization of endometrial carcinoma. Nature. 2013;497:67–73.

    Article  Google Scholar 

  • Chino JP, Jones E, Berchuck A, et al. The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer. Int J Radiat Oncol Biol Phys. 2012;82:1872–9.

    Article  Google Scholar 

  • Cardenes HR, Look K, Michael H, et al. Endometrium. In: Halperin CE, Perez CA, Brady LW, et al., editors. Principles and practice of radiation oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 1610–28.

    Google Scholar 

  • Creutzberg CL, Fleming GF. Endometrial Cancer. In: Gunderson LL, Tepper JE, editors. Clinical radiation oncology. 4th ed. Philadelphia: Churchill Livingstone; 2015. p. 1203–1229.e7.

    Google Scholar 

  • Creutzberg CL, van Putten WL, Koper PC, et al. 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. 2000;355:1404–11.

    Article  CAS  Google Scholar 

  • Creutzberg CL, Nout RA, Lybeert ML, et al. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;81:e631–8.

    Article  Google Scholar 

  • FIGO Committee. On gynecologic oncology. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009;104:179.

    Article  Google Scholar 

  • Greven K, Winter K, Underhill K, et al. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high risk endometrial cancer. Gynecol Oncol. 2006;103:155–9.

    Article  CAS  Google Scholar 

  • Hogberg T, Signorelli M, de Oliveira CF, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer--results from two randomised studies. Eur J Cancer. 2010;46(13):2422–31.

    Article  CAS  Google Scholar 

  • Hsu IJ, Alektiar KM, Nori D. Cancer of the endometrium. In: Leibel SA, Phillips TL, editors. Textbook of radiation oncology. 3rd ed. Philadelphia: Saunders; 2010. p. 1026–51.

    Chapter  Google Scholar 

  • Jhingran A, Winter K, Portelance L, et al. A phase II study of intensity modulated radiation therapy to the pelvis for postoperative patients with endometrial carcinoma: radiation therapy oncology group trial 0418. Int J Radiat Oncol Biol Phys. 2012;84(1):e23–8.

    Article  Google Scholar 

  • Johnson N, Cornes P. Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta-analysis. BJOG. 2007;114(11):1313–20.

    Article  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Klopp AH, Moughan J, Portelance L, et al. Hematologic toxicity in RTOG 0418: a phase 2 study of postoperative IMRT for gynecologic cancer. Int J Radiat Oncol Biol Phys. 2013;86(1):83–90.

    Article  CAS  Google Scholar 

  • Klopp A, Smith BD, Alektiar K, et al. The role of postoperative radiation therapy for endometrial cancer: executive summary of an American Society for Radiation Oncology evidence-based guide- line. Pract Radiat Oncol. 2014;4:137–44.

    Article  Google Scholar 

  • Kong A, Simera I, Collingwood M, et al. Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta-analysis. Ann Oncol. 2007;18(10):1595–604.

    Article  CAS  Google Scholar 

  • Kuoppala T, Mäenpää J, Tomas E, et al. Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy. Gynecol Oncol. 2008;110:190–5.

    Article  Google Scholar 

  • Lee CM, Szabo A, Shrieve DC, et al. Frequency and effect of adjuvant radiation therapy among women with stage I endometrial adenocarcinoma. JAMA. 2006;295:389–97.

    Article  CAS  Google Scholar 

  • Lupe K, Kwon J, D’Souza D, et al. Adjuvant paclitaxel and carboplatin chemotherapy with involved field radiation in advanced endometrial cancer: a sequential approach. Int J Radiat Oncol Biol Phys. 2007;67(1):110–6.

    Article  CAS  Google Scholar 

  • Maggi R, Lissoni A, Spina F, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer. 2006;95(3):266–71.

    Article  CAS  Google Scholar 

  • McMeekin DS, Filiaci VL, Aghajanian C, et al. A randomized phase III trial of pelvic radiation therapy (PXRT) versus vaginal cuff brachytherapy followed by paclitaxel/carboplatin chemotherapy (VCB/C) in patients with high risk (HR), early stage endometrial cancer (EC): a gynecologic oncology group trial. Gynecol Oncol. 2014;134(2):438.

    Article  Google Scholar 

  • Meyer LA, Bohlke K, Powell MA, et al. Postoperative radiation therapy for endometrial cancer: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology evidence-based guideline. J Clin Oncol. 2015;33(26):2908–13.

    Article  CAS  Google Scholar 

  • Morrow CP, Bundy BN, Homesley HD. Doxorubicin as an adjuvant following surgery and radiation therapy in patients with high-risk endometrial carcinoma, stage I and occult stage II: a gynecologic oncology group study. Gynecol Oncol. 1990;36(2):166–71.

    Article  CAS  Google Scholar 

  • National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) (2016). http://seer.cancer.gov/statfacts/html/corp.html. Accessed 22 Aug 2016. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Endometrial cancers (Version 2.2016). 2016. https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed on 22 Aug 2016.

  • Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009;27(21):3547–56.

    Article  Google Scholar 

  • Nout RA, Smit V, 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(9717):816–23.

    Article  CAS  Google Scholar 

  • Nout RA, van de Poll-Franse LV, Lybeert MLM, et al. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011;29(13):1692–700.

    Article  Google Scholar 

  • Onsrud M, Cvancarova M, Hellebust TP, et al. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol. 2013;31:3951–6.

    Article  Google Scholar 

  • Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103–4.

    Article  Google Scholar 

  • Randall ME, Filiaci VL, Muss H, et al. 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. 2006;24:36–44.

    Article  CAS  Google Scholar 

  • Reed NS, Mangioni C, Malstrom H, et al. Phase III randomized study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European organization for research and treatment of cancer gynaecological cancer group study (protocol 55874). Eur J Cancer. 2008;44:808–18.

    Article  CAS  Google Scholar 

  • Sampath S, Schultheiss TE, Ryu JK. The role of adjuvant radiation in uterine sarcomas. Int J Radiat Oncol Biol Phys. 2010;76(3):728–34.

    Article  Google Scholar 

  • Scholten AN, van Putten WLJ, Beerman H, et al. 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. 2005;63:834–8.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Small W, Mell LK, Anderson P, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71(2):428–34.

    Article  Google Scholar 

  • Small W Jr, Beriwal S, Demanes DJ, et al. American brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachyther- apy after hysterectomy. Brachytherapy. 2012;11:58–67.

    Article  Google Scholar 

  • Sorbe B, Nordström B, Mäenpää J, et al. Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer. 2009;19(5):873–8.

    Article  Google Scholar 

  • Sorbe B, Horvath G, Andersson H, et al. 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;82:1249–55.

    Article  Google Scholar 

  • Susumu N, Sagae S, Udagawa Y, et al. 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. 2008;108(1):226–33.

    Article  CAS  Google Scholar 

  • Viswanathan AN, Moughan J, Miller BE, et al. NRG oncology/RTOG 0921: a phase 2 study of postoperative intensity-modulated radiotherapy with concurrent cisplatin and bevacizumab followed by carboplatin and paclitaxel for patients with endometrial cancer. Cancer. 2015;121(13):2156–63.

    Article  CAS  Google Scholar 

  • Viswanathan AN, Winter K, Miller BE, et al. Updated 4-year results for NRG oncology/RTOG 0921: a phase 2 study of postoperative intensity modulated radiation therapy with concurrent Cisplatin and Bevacizumab followed by carboplatin and paclitaxel for patients with endometrial cancer. Int J Radiat Oncol Biol Phys. 2016;96(2S):S49–50.

    Article  Google Scholar 

  • Wolfson A, Brady M, Rocereto T, et al. Gynecologic oncology group. Randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol. 2007;107(2):177–85.

    Article  CAS  Google Scholar 

Download references

Acknowledgment

We thank R. Scott Bermudez MD and Kim Huang MD for their work on the prior edition of this chapter.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I-Chow J. Hsu .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Choi, S., Hsu, IC.J. (2018). Endometrial Cancer. In: Hansen, E., Roach III, M. (eds) Handbook of Evidence-Based Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-62642-0_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62642-0_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62641-3

  • Online ISBN: 978-3-319-62642-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics