Endometrial Cancer Guideline: ASCO Endorses ASTRO Doc

Roxanne Nelson

July 06, 2015

The American Society of Clinical Oncology (ASCO) has endorsed a clinical practice guideline on postoperative radiation therapy for women with endometrial (uterine) cancer that were developed and published by the American Society for Radiation Oncology (ASTRO) (Pract Radiat Oncol. 2014;4:137-144).

ASCO has determined that the recommendations in the ASTRO guideline are clear, thorough, and based on the most relevant scientific evidence. They outline therapeutic interventions that both societies agree should be the standard of care for women with endometrial cancer.

The endorsement was published online July 6 in the Journal of Clinical Oncology.

"Despite the fact that endometrial cancer is the most common gynecologic cancer in the United States, there is a lot of controversy about how best to treat it," said Larissa A. Meyer, MD, MPH, FACOG, cochair of the ASCO expert panel that endorsed the guideline. "We hope that this endorsement will help standardize treatments so that all women receive the best care possible," she said in a statement.

Surgery is the primary treatment for endometrial cancer, and women with early-stage disease and a low risk for recurrence generally do not need further treatment. But for those at intermediate or high risk for recurrence, adjuvant therapy options continue to evolve.

Alexi A. Wright, MD, MPH, cochair of the ASCO expert panel, said in a release that a goal of this guideline was to reduce unnecessary and potentially harmful treatment for low-risk women, while at the same time increasing the use of combined radiation and chemotherapy in those who face a high risk for recurrence.

"We need to improve outcomes for women with endometrial cancer," she said.

Key Guideline Recommendations
After total abdominal hysterectomy with or without lymph node dissection, it is reasonable to avoid radiation therapy if women have grade 1 or 2 cancers with either no invasion or less than 50% invasion of the myometrium
Vaginal cuff brachytherapy may be considered in patients with negative node dissection with grade 3 tumor without myometrial invasion and in those with negative node dissection with grade 1 or 2 tumors with less than 50% myometrial invasion and higher-risk features, such as age older than 60 years and lymphovascular space invasion
Vaginal cuff brachytherapy is as effective as pelvic radiation at preventing vaginal recurrence for patients with grade 1 or 2 tumors with 50% myometrial invasion or with grade 3 tumors with less than 50% myometrial invasion
Patients with grade 3 cancer with at least 50% myometrial invasion or cervical stroma invasion could benefit from pelvic radiation to reduce the risk for pelvic recurrence
The best available evidence at this time suggests that reasonable options for the adjuvant treatment of patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder, or rectum include external-beam radiation therapy, as well as adjuvant chemotherapy (the best evidence for this population supports the use of chemotherapy, but consideration of external-beam radiation therapy is reasonable)
Prospective data are lacking to validate the use of vaginal brachytherapy after pelvic radiation, and most retrospective studies show no evidence of benefit, although patient numbers have been small; use of vaginal brachytherapy in patients also undergoing pelvic external-beam radiation is not generally warranted, unless risk factors for vaginal recurrence are present

 

The panel notes that participation in clinical trials should be encouraged, given the questions that remain about the optimal postoperative treatment of endometrial cancer, particularly for women with high-risk disease.

They point out that any discussion about postoperative treatments must include the potential impact on both short- and longer-term quality of life. And importantly, the management of premenopausal women should include a discussion of the effect of treatment on fertility and the options available for preserving fertility.

J Clin Oncol. Published online July 6, 2015. Abstract

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