Radiation Therapy in Early Stage Endometrial Cancer: Update and ...

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Radiation Therapy in Uterine Cancer • Long history • 1st report published in 1909 • Heyman (1935) reported a 58.2% 5-yr survival in early stage pts with the “Stockholm Method” (radium packing) • Demonstrated curative potential of RT Heyman and Colleagues Radiumhemmet (1930s)
Historical Perspective • Soon became commonplace, particularly pre-op • By the 1980s, preoperative RT use declined • Today, RT is almost exclusively delivered post-operatively in pts with adverse pathologic features • Pelvic RT and/or vaginal brachytherapy (VB) • Enthusiasm has waned for other previously popular approaches, e.g. whole abdominal RT (WART) and intra-peritoneal 32 P
Page 1: Radiation Therapy in Early Stage En
Page 5 and 6: Preoperative RT Arguments Offered F
Page 7 and 8: Preoperative RT Serious complicatio
Page 9 and 10: Preoperative RT Stronger rationale
Page 11 and 12: Preoperative RT What is the preferr
Page 13 and 14: Preoperative RT Technique • ICB,
Page 15 and 16: Is there a Future for Preoperative
Page 17 and 18: Postoperative RT
Page 19 and 20: All Patients Receive Adjuvant RT Ev
Page 21 and 22: Postoperative RT Rationale • Earl
Page 23 and 24: More useful to combine grade and MI
Page 25 and 26: Rationale also provided by the corr
Page 27 and 28: Postoperative RT in Clinical Stage
Page 29 and 30: What evidence supports the use of a
Page 31 and 32: Postoperative RT Stage I-II Disease
Page 33 and 34: Retrospective studies suggest a ben
Page 35 and 36: 608 stage IA-IIA patients 22% pts w
Page 37 and 38: Clinical Stage I N=540 TAH-BSO with
Page 39 and 40: Norwegian Trial No overall benefit
Page 41 and 42: PORTEC Trial Irradiated pts had a s
Page 43 and 44: Stage IB-II (occult) N=392 TAH-BSO
Page 45 and 46: Survival Keys et al. Gynecol Oncol
Page 47 and 48: Stage IA-IIA Intermediate/High Risk
Page 49 and 50: What do these trials teach us?
Page 51 and 52: Lesson 2 Adjuvant Pelvic RT is asso
Page 53 and 54:
Intensity Modulated RT • Intensit
Page 55 and 56:
What do the randomized trials not t
Page 57 and 58:
Is Survival Increased? • None of
Page 59 and 60:
Limitation #2 Only two trials conta
Page 61 and 62:
Meta-analysis of adjuvant RT in sta
Page 63 and 64:
Review of SEER data 4010 stage IC g
Page 65 and 66:
Immediate versus Delayed RT • Sal
Page 67 and 68:
Overall Survival is Poor Particular
Page 69 and 70:
Recommendation • Adjuvant RT shou
Page 71 and 72:
Optimal Approach • Much is made o
Page 73 and 74:
With adequate surgical staging, out
Page 75 and 76:
A Phase III trial is needed compari
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So what to do with the individual p
Page 79 and 80:
Stage I Patients Limited*/No Lymph
Page 81 and 82:
256 stage I with deep MI on 7 studi
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In surgically staged patients, VB a
Page 85 and 86:
In stage II patients, base decision
Page 87 and 88:
As in stage I patients, one should
Page 89 and 90:
A strong rationale exists for chemo
Page 91 and 92:
The Europeans have completed such a
Page 93 and 94:
Chemotherapy alone does not control
Page 95 and 96:
Clinical Stage I-II TAH BSO Surgica
Page 97 and 98:
To test a more aggressive regimen,
Page 99 and 100:
Loco-regional control was high (>95
Page 101:
Conclusions • RT continues to pla
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