The American Society for Radiation Oncology (ASTRO) has released newly updated clinical guidelines on the use of radiation therapy and systemic therapy after surgery to treat patients with endometrial cancer. The guideline also considers the role of surgical staging and molecular profiling techniques in determining whether a patient should receive post-operative therapy. The guideline will be published in the January/February 2023 issue of Practical Radiation Oncology.
Endometrial cancer is the most common type of gynecological cancer in the U.S., with more than 60,000 estimated new diagnoses each year. Standard treatment involves surgical removal of the patient’s uterus, cervix, fallopian tubes and ovaries, with additional post-operative therapy indicated for patients with risk factors for cancer recurrence.
“Since ASTRO published its original endometrial cancer guideline in 2014, multiple research teams have published high-quality clinical trials on the usefulness of post-operative therapy for patients with different disease stages and risk profiles,” said Beth A. Erickson, MD, FASTRO, chair of the guideline task force and a professor of radiation oncology at the Medical College of Wisconsin in Milwaukee.
“For patients with an elevated risk of recurrence following endometrial cancer surgery, clinical trials consistently show that adjuvant therapy can improve outcomes,” she said. “Our task force synthesized findings from these trials into recommendations for external beam radiation, brachytherapy and chemotherapy in the post-surgical setting, with a focus on multidisciplinary, patient-centered care.”
The guideline task force also considered new trials on the accuracy of surgical staging techniques and the increasing role of molecular profiling for endometrial tumors in guiding adjuvant therapy decisions. Matthew M. Harkenrider, MD, vice chair of the guideline task force and an associate professor of radiation oncology at Loyola University Chicago said, “Researchers have identified several potential biomarkers for endometrial cancer and are now exploring whether these molecular markers can help determine which patients will benefit from adjuvant therapy.”
The guideline includes treatment algorithms for stage I-II endometrial cancers, stage I-II cancers with high-risk histologies and stage III-IVA cancers. It details the recommended use of external beam radiation therapy (EBRT), vaginal brachytherapy (VBT) and chemotherapy for patients with different risk profiles, as well as which patients should not receive adjuvant therapy. Key recommendations are as follows:
The guideline was based on a systematic literature review of articles published through August 2021. The multidisciplinary task force of subject matter experts included radiation oncologists, medical oncologists and gynecological oncologists, a medical physicist, a radiation oncology resident and a patient representative. The guideline was developed in collaboration with the American Brachytherapy Society, the American Society of Clinical Oncology and the Society of Gynecologic Oncology. It is endorsed by the Canadian Association of Radiation Oncology, European Society for Radiotherapy and Oncology, and the Royal Australian and New Zealand College of Radiologists.Back To Top
Updated Endometrial Cancer Guidelines Released by ASTRO. Appl Rad Oncol.