Last updated January 10, 2022

Role Of Postoperative Radiation Therapy For Endometrial Cancer

Guideline statements

Which patients with endometrioid endometrial cancer require no additional therapy after hysterectomy?

Following total abdominal hysterectomy with or without node dissection, no radiation therapy is a reasonable option for patients with:
  • 1) no residual disease in the hysterectomy specimen despite positive biopsy OR
(Strong, Low)
323259
  • 2) grade 1 or 2 cancers with either no invasion or less than 50% myometrial invasion, especially when no other high-risk features are present.
(, )
323259
Patients with the following pathologic features may be reasonably treated with or without vaginal brachytherapy:
  • 1) grade 3 cancers without myometrial invasion OR
(Strong, Low)
323259
  • 2) grade 1 or 2 cancers with less than 50% myometrial invasion and higher risk features such as age greater than 60 and/or lymphovascular space invasion.
(, )
323259

Which patients with endometrioid endometrial cancer should receive vaginal cuff radiation?

Vaginal cuff brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence for patients with:
  • grade 1 or 2 cancers with ≥50% myometrial invasion OR
  • grade 3 tumors with b50% myometrial invasion.
(, )
323259
Vaginal cuff brachytherapy is preferred to pelvic radiation in patients with these risk factors particularly in patients who have had comprehensive nodal assessment. (Strong, Low)
323259

Which women with early stage endometrial cancer should receive postoperative external beam radiation?

Pelvic radiation is an effective means of decreasing pelvic recurrence for early stage patients but has not been proven to improve overall survival. Patients with grade 3 cancer with ≥50% myometrial invasion or cervical stroma invasion may benefit from pelvic radiation to reduce the risk of pelvic recurrence. (Strong, High)
323259
Patients with grade 1 or 2 tumors with ≥50% myometrial invasion may also benefit from pelvic radiation to reduce pelvic recurrence rates if other risk factors are present such as age >60 years and/or lymphovascular space invasion. (Strong, High)
323259

Which women with stage III-IVA endometrial cancer should receive postoperative external beam radiation?

The use of pelvic radiation has been shown to improve survival in some settings. The best available evidence at this time suggests that a reasonable option for adjuvant treatment of patients with positive nodes, or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder, or rectum includes external beam radiation therapy as well as adjuvant chemotherapy. (Strong, Moderate)
323259
Chemotherapy OR (, Moderate)
(weak)
323259
radiation therapy alone (, Low)
(weak)
323259
may be considered for some patients based on pathologic risk factors for pelvic recurrence.

When should brachytherapy be used in addition to external beam radiation?

Prospective data is lacking to validate the use of vaginal brachytherapy after pelvic radiation and retrospective studies show little conclusive evidence of a benefit, albeit with small patient numbers. Use of vaginal brachytherapy in patients also undergoing pelvic external beam radiation may not generally be warranted, unless risk factors for vaginal recurrence are present. (, Low)
(weak)
323259

How should radiation therapy and chemotherapy be integrated in the management of endometrial cancer?

The best available evidence suggests that concurrent chemoradiation followed by adjuvant chemotherapy is indicated for patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder, or rectum. (Strong, Moderate)
323259
Alternative sequencing strategies with external beam radiation and chemotherapy are also acceptable. (, Low)
(weak)
323259
Chemotherapy OR
323259
radiation therapy alone (, Low)
323259
may be considered for some patients based on pathologic risk factors for pelvic recurrence.

Recommendation Grading

Overview

Title

Role Of Postoperative Radiation Therapy For Endometrial Cancer

Authoring Organization

Publication Month/Year

June 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To present evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer.

Target Patient Population

Patients with endometrial cancer

Inclusion Criteria

Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Radiology services

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D018787 - Radiation Oncology, D011827 - Radiation, D016889 - Endometrial Neoplasms

Keywords

radiation therapy, Adjuvant Radiation Therapy, endometrial cancer