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

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VB may not be necessary in stage IIA pts undergoing pelvic RT Calvin DB, Connell PP, Rotmensch J, Mundt AJ Surgery and Postoperative RT in Stage II Endometrial Cancer AJCO 1999;22:338 44 pathologic Stage II patients 32 (73%) Stage IIA disease 18/32 stage IIA pts treated with pelvic RT alone None failed in the pelvis Median follow-up 40 months
As in stage I patients, one should favor VB alone in surgically staged stage II patients Stage II Patients Surgically Staged Patients* Grade 1 Grade 2 Grade 3 IIA ≤½ MI VB 1 VB 1 VB 1 >½ MI VB 2 VB 2 VB 2 IIB Pelvic+VB 3 Pelvic+VB 3 Pelvic+VB 3 *>15 nodes, multiple sites (arbitrary cutoff) 1 low risk of nodal involvement 2 favor pelvic RT if not extensive nodal surgery 3 only do VB alone reluctantly if extensive nodal surgery (note: pre-sacral lymph nodes are not routinely assessed!)
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Radiation Therapy in Early Stage En
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Historical Perspective • Soon bec
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Preoperative RT Arguments Offered F
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Preoperative RT Serious complicatio
Page 9 and 10:
Preoperative RT Stronger rationale
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Preoperative RT What is the preferr
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Preoperative RT Technique • ICB,
Page 15 and 16:
Is there a Future for Preoperative
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Postoperative RT
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All Patients Receive Adjuvant RT Ev
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Postoperative RT Rationale • Earl
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More useful to combine grade and MI
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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
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Postoperative RT Stage I-II Disease
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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
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: In stage II patients, base decision
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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