• Lukka H, Chambers A, Fyles A, Thephamongkhol K, Elit L, Fung-Kee-Fung M, Kwon J, Oliver T, Gynecology Cancer Disease Site Group. Adjuvant radiotherapy in women with stage I endometrial cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Mar 9. 24 p. (Evidence-based series; no. 4-10). [21 references]

There is a lack of consistent well-conducted randomized controlled trial evidence related to the clinical questions. Based on the interpretation of evidence from the available randomized data and expert consensus opinion, the Gynecology Cancer Disease Site Group recommends the following:

• Regardless of surgical staging, adjuvant external beam radiotherapy:
  • is recommended for patients at high risk of recurrence
  • is not recommended in patients at low risk of recurrence
  • is a reasonable treatment option for patients at intermediate risk of recurrence
    • Two randomized trials detected that adjuvant external beam radiotherapy improved pelvic control, but not survival, when compared to no further treatment.
    • In patients with no adjuvant therapy, salvage radiotherapy may be effective upon vaginal recurrence.
    • When considering adjuvant radiotherapy, the potential improvement in pelvic control needs to be weighed against the toxicity of radiotherapy.
    • Radiotherapy was associated with a low incidence of severe acute and late adverse effects; however, many patients experienced mild (grade 1 or 2) side effects. The long-term effects of radiotherapy are unknown at this time.
• There is insufficient evidence to reliably inform the use of intracavitary radiotherapy either alone or in combination with external beam radiotherapy.
  • One randomized trial detected improvements in pelvic control with combined radiotherapy; however, that trial was published in 1980, toxicity was not well reported, and subsequent trials with similar comparisons have not been identified.
  • There were no randomized trials directly comparing external beam radiotherapy alone versus intracavitary treatment alone.
• Complete surgical staging provides additional pathological information and may help guide treatment decisions involving adjuvant therapies.
• With the potential for substantial grade changes upon pathology review, which may influence decisions regarding adjuvant radiotherapy, it may be important for each jurisdiction to establish a level of quality assurance with specific indications for pathology review. However, the extent to which quality assurance can be determined is outside of the scope of this report.

None provided

The recommendations are supported by randomized controlled trials and systemic reviews.

• Lukka H, Chambers A, Fyles A, Thephamongkhol K, Elit L, Fung-Kee-Fung M, Kwon J, Oliver T, Gynecology Cancer Disease Site Group. Adjuvant radiotherapy in women with stage I endometrial cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Mar 9. 24 p. (Evidence-based series; no. 4-10). [21 references]

Not applicable: The guideline was not adapted from another source.

2006 Mar 9

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Gynecology Cancer Disease Site Group

No potential conflicts of interest were declared.

None available

This NGC summary was completed by ECRI on June 9, 2006. The information was verified by the guideline developer on June 26, 2006.