Treatment Option Overview
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Patients with endometrial cancer who have localized disease are usually curable
by hysterectomy and bilateral salpingo-oophorectomy. Best results are obtained
with either of two standard treatments: hysterectomy or hysterectomy and
adjuvant radiation therapy (when deep invasion of the myometrial muscle [50% of the depth] or grade 3 tumor with myometrial invasion is present). Results
of two randomized trials on the use of adjuvant radiation therapy in patients with
stage I disease did not show improved survival but did show reduced locoregional recurrence (3%–4% vs. 12%–14% after 5–6 years' median follow-up, P < .001) with an increase in side effects.[1-3][Level of evidence: 1iiDii]
Vaginal cuff brachytherapy may be associated with less radiation-related morbidity than pelvic radiation. It has been shown to reduce the risk of vaginal cuff recurrence without an
effect on survival.
Some patients have regional and distant metastases that,
though occasionally responsive to standard hormone therapy, are rarely
curable. For these patients, standard therapy is inadequate.
Progestational agents have been evaluated as adjuvant therapy in a randomized
clinical trial of stage I disease and have been shown to be of no benefit.
These studies, however, were not stratified according to level of progesterone
receptor in the primary tumor. No trials of adjuvant progestins in more
advanced disease are reported. Determination of progesterone receptors in the
primary tumor is encouraged, and entry onto an appropriate adjuvant trial (if
receptor levels are high) should be considered. If no trial is available, data
from receptors on the primary tumor may help guide therapy for recurrent
disease, should it occur.
References
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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 355 (9213): 1404-11, 2000.
[PUBMED Abstract]
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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 92 (3): 744-51, 2004.
[PUBMED Abstract]
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Scholten AN, van Putten WL, 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 63 (3): 834-8, 2005.
[PUBMED Abstract]
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