The standard treatment for operable patients with carcinoma of the endometrium is total abdominal hysterectomy and bilateral salpingooophorectomy with regional lymph node staging. Much controversy exists regarding the use of adjuvant therapy. If patients are divided into various risk groups according to prognostic factors, the consensus is that patients with low-risk tumors (grade 1 or 2 lesions and <50% myometrial invasion) do not significantly benefit from adjuvant irradiation. In patients with intermediate-risk tumors (grade 2 or 3 lesions, myometrial invasion <50%, or no evidence of extrauterine tumor or capillary-like invasion), some institutions still advocate preoperative intracavitary irradiation, whereas a popular approach is to proceed with surgery and administer postoperative irradiation, depending on surgical findings. It is agreed that for patients with high-risk tumors (tumor involvement of the cervix, deep myometrial invasion, or pelvic or periaortic lymph node metastasis) adjuvant preoperative or postoperative radiation therapy is beneficial. A recent trend is to proceed with surgery and administer postoperative radiation therapy as indicated by surgical and pathological assessment. In patients with involvement of the exocervix or gross cervical involvement (stage II), we advocate preoperative irradiation (20 Gy to the whole pelvis and 30 Gy to parametrium with midline shield) combined with intracavitary insertion for 5000 to 6000 mgh Ra eq. Patients with clinical stage m and IV disease are treated with a combination of external beam irradiation (20 to 40 Gy to the whole pelvis and additional parametrial dose to complete 50 Gy with midline block) and brachytherapy insertion as necessary. Techniques of irradiation and results of therapy at multiple institutions are discussed. It is imperative to accurately define prognostic features in patients with endometrial carcinoma and to tailor adjuvant irradiation accordingly to achieve the highest possible tumor control, lowest incidence of vaginal or pelvic recurrences, and a high quality of life.
|Number of pages||29|
|State||Published - 1995|