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Pract Radiat Oncol


PURPOSE: With the results of several recently published clinical trials, this guideline informs on the use of adjuvant radiation therapy (RT) and systemic therapy in the treatment of endometrial cancer. Updated evidence-based recommendations provide indications for adjuvant RT and the associated techniques, the utilization and sequencing of adjuvant systemic therapies, as well as the impact of surgical staging techniques and molecular tumor profiling.

METHODS: The American Society for Radiation Oncology (ASTRO) convened a multidisciplinary task force to address 6 key questions that focused on the adjuvant management of patients with endometrial cancer. The key questions emphasized the 1) indications for adjuvant RT, 2) RT techniques, target volumes, dose-fractionation, and treatment planning aims, 3) indications for systemic therapy, 4) sequencing of systemic therapy with RT, 5) impact of lymph node assessment on utilization of adjuvant therapy, and 6) impact of molecular tumor profiling on utilization of adjuvant therapy. Recommendations were based on a systematic literature review and created using consensus-building and ASTRO's Guideline Methodology for quality of evidence grading and strength of recommendation.

RESULTS: The task force recommends RT (either vaginal brachytherapy or external beam radiation therapy [EBRT]) be given based on the patient's clinical-pathologic risk factors to reduce risk of vaginal and/or pelvic recurrence. When EBRT is delivered, intensity modulated radiation therapy with daily image guided radiation therapy is recommended to reduce acute and late toxicity. Chemotherapy is recommended for patients with FIGO stage I-II with high-risk histologies and those with FIGO stage III-IVA with any histology. When sequencing chemotherapy and RT, there is limited data and no prospective data to support an optimal sequence. Sentinel lymph node mapping is recommended over pelvic lymphadenectomy for surgical nodal staging, and use of adjuvant therapy should be based on the pathologic ultrastaging status with isolated tumor cells treated as node negative and micrometastasis treated as node positive. The available data on molecular characterization of endometrial cancer is compelling and should be increasingly considered when making recommendations for adjuvant therapy.

CONCLUSIONS: These recommendations guide evidence-based best clinical practices on the use of adjuvant therapy for endometrial cancer.

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ePub ahead of print

Available for download on Sunday, October 22, 2023