In the Journals

ASCO endorses ASTRO recommendations for postoperative radiation in endometrial cancer

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July 6, 2015

ASCO has endorsed guidelines from the American Society of Radiation Oncology on radiation therapy after surgery for patients with endometrial cancer, according to an article published in Journal of Clinical Oncology.

Many women with early-stage endometrial cancer and a low risk for recurrence require no additional treatment after surgery, according to the ASCO publication. However, adjuvant treatment for women at an intermediate or high risk for recurrence — including radiation therapy, chemotherapy or a combination of the two — continue to evolve.

“Despite the fact that endometrial cancer is the most common gynecologic cancer in the U.S., there is a lot of controversy about how best to treat it,” Larissa A. Meyer, MD, MPH, FACOG, assistant professor of gynecologic oncology and reproductive medicine at The University of Texas MD Anderson Cancer Center and co-chair of the ASCO Endorsement Panel, said in a press release. “We hope that this endorsement will help standardize treatments, so that all women receive the best care possible.”

The American Society of Radiation Oncology (ASTRO) published a series of recommendations for the use of postoperative radiation therapy in patients with endometrial cancer in 2014 in Practical Radiation Oncology.

The recommendations included:

  • surveillance without adjuvant radiation therapy for women who underwent hysterectomy with or without lymph node dissection, who have grade 1 or 2 tumors with no invasion or less than 50% invasion of the myometrium;
  • vaginal cuff brachytherapy for patients with grade 3 tumors with less than 50% myometrial invasion; and,
  • pelvic radiation and adjuvant chemotherapy for patients with grade 3 tumors and 50% or greater myometrial invasion.

The ASCO panel reviewed ASTRO’s guideline recommendations and judged them to be clear, thorough and representative of the most relevant scientific information.

However, the panel offered qualifying statements for several of ASTRO’s recommendations. Although ASTRO endorsed the use of pelvic radiation — with or without vaginal cuff brachytherapy — for patients with grade 1 or 2 tumors and 50% or greater myometrial invasion, ASCO recommends vaginal cuff brachytherapy as a superior option for this patient population.

Further, although ASTRO recommended radiation therapy without chemotherapy for patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder or rectum,

ASCO also recommends the use of chemotherapy in these patients.

ASTRO endorsed concurrent chemoradiation followed by adjuvant chemotherapy for patients with positive nodes. Although ASCO noted this recommendation is based on expert opinion and limited data, clinical trials are underway to provide more insight in this area.

Alexi Wright

Alexi A. Wright

“The goal of this guideline is to reduce unnecessary and potentially harmful treatment of women who are at a low risk for developing recurrent cancers, while increasing the use of combined radiation and chemotherapy in women who are at high risk for recurrence and therefore need treatment,” Alexi A. Wright, MD, MPH, assistant professor of medicine at Harvard Medical School and co-chair of the ASCO Endorsement Panel, said in a press release. “We need to improve outcomes for women with endometrial cancer."by Cameron Kelsall

Disclosure: Meyer reports receiving travel expenses from AstraZeneca. Wright reports no relevant financial disclosures. Please see the full article for a list of all other authors’ relevant financial disclosures.