The American Society for Radiation Oncology (ASTRO) has updated its 2014 guideline on the use of radiation therapy and systemic therapy after surgery to treat patients with endometrial cancer.
Key updates include the consideration of the role of surgical staging and molecular profiling techniques to help determine whether patients should receive postoperative therapy. The guideline will be available in the January/February 2023 issue of Practical Radiation Oncology.
The guideline includes treatment algorithms for stage I-II endometrial cancers, stage I-II cancers with high-risk histologies and stage III-IVA cancers. It details the recommended use of external beam radiation therapy (EBRT), vaginal brachytherapy (VBT), and chemotherapy for patients with different risk profiles, as well as which patients should not receive adjuvant therapy, ASTRO said, in a news release.
Key recommendations are as follows:
- Based on a patient's clinical-pathologic risk factors, radiation therapy is recommended to reduce the risk of locoregional recurrence. The choice of EBRT versus VBT in FIGO stage I endometrial cancer should depend on lymph node assessment and uterine risk factors. EBRT is recommended for patients with stage I disease with high-risk features, stage II disease, or stage III-IVA disease.
- Systemic chemotherapy should be effectively sequenced with radiation therapy for patients with high-risk histologies and/or stage III-IVA disease to decrease the risk of distant and locoregional recurrence, respectively.
- When EBRT is indicated, the use of intensity-modulated radiation therapy with daily image guidance is associated with improved patient-reported outcomes and reduced side effects. Recommendations in the guideline also outline optimal radiation dosing, treatment planning, and delivery techniques based on the patient's cancer stage and histology.
- For surgical nodal staging, sentinel lymph node mapping is recommended over pelvic lymphadenectomy, and the use of adjuvant therapy should be based on a patient's pathologic ultrastaging status.
- Molecular tumor profiling is recommended and may be used to guide recommendations for adjuvant therapy.
ASTRO's clinical guidelines are intended as tools to promote appropriately individualized, shared decision-making between physicians and patients, the organization said.
