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

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RTOG 9708 • Unsurprisingly, acute toxicities were significant (predominantly hematologic) – 29% grade 3-4 (concomitant phase) – 83% grade 3-4 (chemotherapy phase) • High rate of chronic toxicity also seen – 41% grade 2, 16% grade 3, 5% grade 4
Loco-regional control was high (>95%), Extra-pelvic recurrences were common (4-yr distant metastases 19%) 2-yr DFS 83% Based on these results, a randomized trial was initiated (RTOG 9905) Unfortunately, closed due to poor accrual
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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
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Preoperative RT Stronger rationale
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Preoperative RT What is the preferr
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Preoperative RT Technique • ICB,
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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
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Postoperative RT in Clinical Stage
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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
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608 stage IA-IIA patients 22% pts w
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Clinical Stage I N=540 TAH-BSO with
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Norwegian Trial No overall benefit
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PORTEC Trial Irradiated pts had a s
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Stage IB-II (occult) N=392 TAH-BSO
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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 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: To test a more aggressive regimen,
Page 101: Conclusions • RT continues to pla
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Radiation Therapy in Early Stage Endometrial Cancer: Update and ...

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