Navigation Links
ASTRO issues guideline on the role of postoperative radiation therapy for endometrial cancer
Date:4/23/2014

Fairfax, Va., April 23, 2014 The American Society for Radiation Oncology (ASTRO) has issued a new guideline, "The Role of Postoperative Radiation Therapy for Endometrial Cancer: An ASTRO Evidence-Based Guideline," that details the use of adjuvant radiation therapy in the treatment of endometrial cancer. The guideline's executive summary is published in the May-June 2014 issue of Practical Radiation Oncology (PRO), the official clinical practice journal of ASTRO. The full-length guideline is available as an open-access article online at http://www.practicalradonc.org.

ASTRO's Guidelines Panel of 17 leading gynecologic specialists compiled and reviewed extensive data from 330 studies from MEDLINE, EMBASE and the Specialized Register of the Cochrane Gynaecological Cancer Review Group published from 1980 to 2011. The data population selected for the guideline was defined as women of all races, age 18 or older, with stage I-IV endometrial cancer of any histologic type or grade. The studies included patients who underwent a hysterectomy followed by no adjuvant therapy, or pelvic and/or vaginal brachytherapy with or without systemic chemotherapy. The panel identified five key questions about the role of adjuvant radiation therapy and developed a series of recommendations to address each question.

The first Key Question addresses which patients with endometrioid endometrial cancer require no additional therapy after hysterectomy. For patients with no residual disease in the hysterectomy specimen despite positive biopsy or grade 1 or 2 cancers with either no invasion or <50 percent myometrial invasion, especially when no other high-risk features are present, no adjuvant radiation therapy is a reasonable option. Patients with grade 3 cancers without myometrial invasion or grade 1 or 2 cancers with <50 percent myometrial invasion and higher risk factors such as age >60 and/or lymphovascular space invasion could reasonably be treated with or without vaginal cuff brachytherapy.

Key Question 2 examines which patients with endometrioid endometrial cancer should receive vaginal cuff radiation. Evidence demonstrates that cuff brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence for patients with 1) grade 1 or 2 cancers with ≥50 percent myometrial invasion or 2) grade 3 tumors with <50 percent myometrial invasion. Vaginal cuff brachytherapy is preferred to pelvic radiation in patients with these risk factors particularly in patients who have had comprehensive nodal assessment.

Key Question 3 details which women should receive postoperative external beam radiation. Patients with early stage endometrial cancer which is grade 3 with ≥50 percent myometrial invasion or cervical stroma invasion are felt to benefit from pelvic radiation to reduce the risk of pelvic recurrence. Patients with grade 1 or 2 tumors with ≥50 percent myometrial invasion may also benefit from pelvic radiation to reduce pelvic recurrence rates if other risk factors are presents such as age >60 years and/or lymphovascular space invasion. For patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder or rectum, the best available evidence suggests that treatment should include external beam radiation therapy as well as adjuvant chemotherapy. Chemotherapy or radiation therapy alone may be considered for some patients based on pathologic risk factors for pelvic recurrence.

Key Question 4 addresses when brachytherapy should be used in addition to external beam radiation. The panel noted that data is lacking to validate the use of brachytherapy after pelvic radiation and that 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.

Key Question 5 examines how radiation therapy and chemotherapy should be integrated in the management of endometrial cancer. The panel concluded that 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. Alternative sequencing strategies with external beam radiation and chemotherapy are also acceptable. Chemotherapy or radiation therapy alone may be considered for some patients based on pathologic risk factors for pelvic recurrence.

"Several trials on the role of radiation therapy in endometrial cancer have been reported in the past five years, seeking to clarify this topic; however these trials have been interpreted in different ways, leading to inconsistent treatment recommendations," said Ann Klopp, MD, PhD, and Akila N. Viswanathan, MD, MPH, co-chairs of the ASTRO Endometrial Guideline Panel. "This guideline provides recommendations to help ensure patients receive the best possible care and to help patients and doctors make informed decisions about treatment options."

The guideline was approved by ASTRO's Board of Directors in September 2013 and is endorsed by the Society of Gynecologic Oncology. The guideline panel members included radiation oncologists, gynecologic oncologists, medical oncologists, a resident in radiation oncology and radiation physicists: Dr. Klopp (co-chair), Dr. Viswanathan (co-chair), Benjamin D. Smith, MD, Kaled Alektiar, MD, Alvin Cabrera, MD, Antonio L. Damato, PhD, Beth Erickson, MD, FASTRO, Gini Fleming, MD, David Gaffney, MD, PhD, Kathryn Greven, MD, FASTRO, Karen Lu, MD, David Miller, MD, David Moore, MD, Daniel Petereit, MD, Tracey Schefter, MD, William Small Jr., MD, FASTRO, and Catheryn Yashar, MD.


'/>"/>

Contact: Michelle Kirkwood
michellek@astro.org
703-286-1600
American Society for Radiation Oncology
Source:Eurekalert

Related medicine news :

1. Some astronauts at risk for cognitive impairment, animal studies suggest
2. Extreme energy efficiency, hot astrophysics, nuclear medicine and more at the 2014 APS April Meeting
3. Researchers develop device that simulates gastro-intestinal tract
4. Study finds astronauts hearts become more spherical in space
5. ASTRO and SSO issue consensus guideline on margins for breast-conserving surgery with WBI
6. New research on diverticular disease in the December issue of Clinical Gastroenterology and Hepatology
7. It’s a Bird, It’s a Plane, It’s a… Buddhist Monk? Crowd Gathers in the Castro for “The Temple” Book Launch
8. MEDIVATORS Inc. and Edison Nation Medical Search for New Medical Invention Ideas to Improve Detection of Lower Gastrointestinal Diseases; Search Concludes Jan. 20, 2014
9. Scientists show how cells protect their DNA from catastrophic damage
10. Gastrointestinal Bleeding Market: Global Clinical Trials Review H2 2013 in New Research Report at RnRMarketResearch.com
11. gGastro Receives ONC-ACB Certification by Drummond Group
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:8/14/2019)... ... August 13, 2019 , ... New Hampshire-based Vera Roasting Company , ... an expansion of its line of CBD-infused coffees with the release of a new ... 12-oz bag. , “We are excited to expand our CBD-infused product lines to ...
(Date:8/14/2019)... ... ... Today, consumers are taking a harder look at what goes into their bodies. ... levels. The trick is finding food and beverages that are delicious and nutritious to ... created Chase – a delicious, guilt free cocktail mixer that doesn’t compromise ...
(Date:8/12/2019)... Md. (PRWEB) , ... August 12, 2019 , ... ... needed adaptive sports rehabilitation thanks to donations received through the 4th annual Lockton ... Club in Bedminster, New Jersey. , Participating in the event again ...
(Date:8/9/2019)... ... August 09, 2019 , ... BayMark ... opioid treatment program (OTP) in Ohio. MedMark Lebanon will provide medically-supervised medication-assisted treatment ... located at 1521 Walmart Drive, is now accepting patients. , “Ohio has ...
(Date:8/8/2019)... ... August 08, 2019 , ... Heritage Woods of South Elgin celebrated 10 ... was held this afternoon. , The affordable assisted lifestyle community, which is located at ... memory care at White Oaks at Heritage Woods of South Elgin and White Oaks ...
Breaking Medicine News(10 mins):
(Date:8/16/2019)... ... August 16, 2019 , ... Today, Point-of-Care Partners announced ... PhD, has joined the company as a Government Affairs and Health IT Strategist. ... industry standards organizations to advance use of health IT for comprehensive medication management. ...
(Date:8/16/2019)... , ... August 16, 2019 , ... ... Eastern Europe since 2005, announced it has successfully completed enrollment of 690 patients ... This is a dose ranging, multicenter, randomized, double-blind, placebo-controlled, home use, parallel group ...
(Date:8/15/2019)... (PRWEB) , ... August 15, 2019 , ... ... annual Inc. 5000 list, the most prestigious ranking of the nation’s fastest-growing private ... the American economy’s most dynamic segment—its independent small businesses. Microsoft, Dell, Domino’s Pizza, ...
Breaking Medicine Technology: