Radiation Oncology/Endometrium/Guidelines

 Endometrial Cancer Guidelines 


 * SFGO: Societe Francaise d'Oncologie Gynecologique
 * 2011 PMID 21697683 -- "Clinical practice guidelines for the management of patients with endometrial cancer in france: recommendations of the Institut National du Cancer and the Société Française d'Oncologie Gynécologique" (Querleu D, Int J Gynecol Cancer. 2011 Jul;21(5):945-50.)
 * Stage I - Low risk (IAG1-G2)
 * Surgery: TH/BSO, PLND not recommended
 * RT: HDR VB if myometrial invasion; EBRT not recommended
 * Chemo: not recommended
 * Stage I - Intermediate risk (IAG3, IBG1-G2)
 * Surgery: TH/BSO, PLND not recommended but can be considered IBG2 or IAG3 with myometrial involvement
 * RT: HDR VB; EBRT not recommended
 * Chemo: not recommended
 * Stage I - High risk (IBG3, IA-B type 2, I with LVI+)
 * Surgery: TH/BSO, P/PALND recommended
 * RT: pelvic EBRT; additional VBT can be considered
 * Chemo: not recommended
 * Stage I - Clear cell or papillary serous
 * Surgery: TH/BSO, P/PALND, infracolic omentectomy, periotoneal cytology, biopsy
 * RT: pelvic EBRT; additional VBT can be considered
 * Chemo: can be considered
 * Stage I - Carcinosarcoma
 * Surgery: TH/BSO, P/PALND
 * RT: pelvic EBRT; additional VBT can be considered
 * Chemo: can be considered
 * Stage II
 * Surgery: Hysterectomy, +/- vaginectomy, PLND,
 * For type I: consider PLND
 * For type II: P/PALND, infracolic omentectomy, peritoneal cytology, biopsy
 * RT: EBRT with HDR VBT; if large volume cervix disease, can consider preop RT
 * Chemo: Can be considered for type 2
 * Stage IIIA
 * Surgery: TH/BSO, infragastric omentectomy, P/PALND, peritoneal cytology
 * RT
 * Serosa alone: pelvic EBT with HDR VBT
 * Cervix affected: HDR VBT
 * Chemo: if adnexa affected
 * Stage IIIB
 * RT as sole therapy is the main option (pelvic EBRT with uterine/vaginal BT)
 * PLND as staging can be considered
 * Chemo: concomitant chemotherapy can be considered
 * Surgery: can be considered if partial response to RT
 * Stage IIIC (pathologic)
 * Surgery: immediate or delayed PALND
 * RT: pelvic RT (IIIC1) or pelvic/para-aortic RT (IIIC2) with HDR VBT
 * Chemo: adjuvant CT must be discussed
 * Stage IIIC1 (imaging)
 * Surgery: TH/BSO, PPALND
 * RT: pelvic EBRT, with VBT
 * Chemo: adjuvant CT may be discussed
 * Stage IIIC2 (imaging)
 * Pelvic and para-aortic RT, followed by lymphatic boost, and uterine/vaginal BT
 * If conditions favorable for surgery, TH/BSO and PPALND recommended, followed by pelvic EBRT and VBT
 * Chemo: must be discussed
 * Stage IV (Bowel/bladder)
 * Pelvic EBRT with BT
 * Chemo: can be considered
 * If RT fails, pelvic exenteration can be considered
 * Stage IV (Distant mets, including intra-abdominal or inguinal nodes)
 * Cytoreductive surgery only for operable peritoneal carcinosis
 * Chemo: recommended
 * Hormone therapy: recommended for ER+
 * RT: pelvic EBRT recommended to primary tumor
 * If inguinal LN, additional lymphadenectomy recommended

Brachytherapy
 * ABS: American Brachytherapy Society
 * 2012: Vaginal cuff PMID 22265439 -- "American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy."
 * Note: also includes indications for vaginal cuff irradiation for cervical cancer