Radiation Therapy for Endometrial Cancer
Publication Date: October 21, 2022
Last Updated: January 6, 2023
Indications for adjuvant RT
- For patients with FIGO stage IA grade 1 or 2 endometrioid carcinoma without intermediate-* or high-risk factors,† adjuvant RT is not recommended.
- Strong, Moderate
- For patients without high-risk factors† and with either FIGO stage IB grade 1 or 2 endometrioid carcinoma or myoinvasive FIGO stage IA grade 3 endometrioid carcinoma, vaginal brachytherapy is recommended.
- Strong, Moderate
- For patients with high-risk factors† and who have FIGO stage IB grade 1 or 2 or myoinvasive FIGO stage IA grade 3 endometrioid carcinoma, EBRT is conditionally recommended.
- Conditional, Moderate
- For patients with FIGO stage IB grade 3 or FIGO stage II endometrioid carcinoma, EBRT is recommended.
- Strong, High
- For patients with myoinvasive FIGO stage IA high-risk histology‡ endometrial carcinoma, vaginal brachytherapy with or without chemotherapy is conditionally recommended.
- Conditional, Low
- For patients with FIGO stage IB or II high-risk histology‡ endometrial carcinoma, EBRT with chemotherapy is conditionally recommended.
- Conditional, Moderate
- For patients with FIGO stage III or IVA endometrial carcinoma of any histology, EBRT with chemotherapy is conditionally recommended to decrease locoregional recurrence.
- Conditional, Moderate
low asterisk Intermediate-risk factors include age ≥60 years, focal LVSI.
† High-risk factors include substantial LVSI, especially without surgical nodal staging.
‡ High-risk histologies include serous carcinoma, clear cell carcinoma, carcinosarcoma, mixed histology carcinoma, dedifferentiated carcinoma, or undifferentiated carcinoma.
† High-risk factors include substantial LVSI, especially without surgical nodal staging.
‡ High-risk histologies include serous carcinoma, clear cell carcinoma, carcinosarcoma, mixed histology carcinoma, dedifferentiated carcinoma, or undifferentiated carcinoma.
Adjuvant RT techniques, target volumes, dose-fractionation regimens, and normal tissue constraints
- For patients with endometrial carcinoma undergoing adjuvant EBRT, IMRT is recommended to reduce acute and late toxicity.
- Strong, Moderate
- For patients with endometrial carcinoma undergoing adjuvant EBRT using IMRT, a vaginal ITV is recommended for treatment planning with daily IGRT for treatment verification.
- Strong, Moderate
- For patients with endometrial carcinoma undergoing adjuvant EBRT, a dose of 4500-5040 cGy at 180-200 cGy per fraction is recommended.
- Strong, Moderate
- For patients with endometrial carcinoma undergoing adjuvant vaginal brachytherapy alone, treating the proximal third to half of the vagina (typically 3-5 cm) is recommended.
- Strong, Moderate
- For patients with endometrial carcinoma with cervical stromal involvement and/or close or positive vaginal margins, postoperative vaginal brachytherapy as a boost after EBRT is conditionally recommended.
- Conditional, Expert opinion
Overview
Title
Radiation Therapy for Endometrial Cancer
Authoring Organization
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