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

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Severe GI toxicity highest in GOG 99 Suggesting an increased risk in surgically staged patients Severe GI Sequelae PORTEC 3% (5-year, actuarial) GOG-99 8% (2-year, crude) In GOG-99, 2 RT pts died from intestinal injury and 6 developed grade 3-4 SBO (compared to 1 non-RT pt)
Intensity Modulated RT • Intensity modulated RT (IMRT) may decrease the risk of severe sequelae • Dosimetric studies demonstrate significant sparing of small bowel, bladder and rectum • Preliminary outcome studies have noted low toxicity rates and excellent pelvic control
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 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: Lesson 2 Adjuvant Pelvic RT is asso
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

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

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