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

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Post-hoc analysis High Intermediate Risk (HIR) patients Age ≥ 70 with 1 of the following risk factors (grade 2-3, LVI, outer 1/3 MI) Age ≥ 50 with 2 factors Any age with all 3 factors Only 1/3 of treated patients A non-significant ↑survival favoring RT Insufficient statistical power 4-year Survival Pelvic RT 88% No Pelvic RT 74% p = NS
Stage IA-IIA Intermediate/High Risk IA-IBg3, IC-IIA N= 905 TAH-BSO Assessment of peritoneal cytology and nodes not required If done, +cyto and +node patients included (1/3 of enrollment) ASTEC/NCIC Regimen 1 Pelvic RT 40-46 Gy/ 1.8-2 Gy fractions VB optional (54%) Regimen 2 “Observation” VB optional (52%) ASTEC/NCIC Committee Lancet 2009;373-46
Page 1 and 2: Radiation Therapy in Early Stage En
Page 3 and 4: Historical Perspective • Soon bec
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: Survival Keys et al. Gynecol Oncol
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
Page 77 and 78: 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
Page 83 and 84: 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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Radiation Therapy in Early Stage Endometrial Cancer: Update and ...

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