Radiation Oncology/Endometrium/Guidelines

Endometrial Cancer Guidelines SFGO: Societe Francaise d'Oncologie Gynecologique 2011 21697683 -- "Clinical practice guidelines for the management of patients with endometrial cancer in france: recommendations of the Institut National du Cancer and the Société Française d'Oncologie Gynécologique" (Querleu D, Int J Gynecol Cancer. 2011 Jul;21(5):945-50.) Stage I - Low risk (IAG1-G2) Surgery: TH/BSO, PLND not recommended RT: HDR VB if myometrial invasion; EBRT not recommended Chemo: not recommended Stage I - Intermediate risk (IAG3, IBG1-G2) Surgery: TH/BSO, PLND not recommended but can be considered IBG2 or IAG3 with myometrial involvement RT: HDR VB; EBRT not recommended Chemo: not recommended Stage I - High risk (IBG3, IA-B type 2, I with LVI+) Surgery: TH/BSO, P/PALND recommended RT: pelvic EBRT; additional VBT can be considered Chemo: not recommended Stage I - Clear cell or papillary serous Surgery: TH/BSO, P/PALND, infracolic omentectomy, periotoneal cytology, biopsy RT: pelvic EBRT; additional VBT can be considered Chemo: can be considered Stage I - Carcinosarcoma Surgery: TH/BSO, P/PALND RT: pelvic EBRT; additional VBT can be considered Chemo: can be considered Stage II Surgery: Hysterectomy, +/- vaginectomy, PLND, For type I: consider PLND For type II: P/PALND, infracolic omentectomy, peritoneal cytology, biopsy RT: EBRT with HDR VBT; if large volume cervix disease, can consider preop RT Chemo: Can be considered for type 2 Stage IIIA Surgery: TH/BSO, infragastric omentectomy, P/PALND, peritoneal cytology RT Serosa alone: pelvic EBT with HDR VBT Cervix affected: HDR VBT Chemo: if adnexa affected Stage IIIB RT as sole therapy is the main option (pelvic EBRT with uterine/vaginal BT) PLND as staging can be considered Chemo: concomitant chemotherapy can be considered Surgery: can be considered if partial response to RT Stage IIIC (pathologic) Surgery: immediate or delayed PALND RT: pelvic RT (IIIC1) or pelvic/para-aortic RT (IIIC2) with HDR VBT Chemo: adjuvant CT must be discussed Stage IIIC1 (imaging) Surgery: TH/BSO, PPALND RT: pelvic EBRT, with VBT Chemo: adjuvant CT may be discussed Stage IIIC2 (imaging) Pelvic and para-aortic RT, followed by lymphatic boost, and uterine/vaginal BT If conditions favorable for surgery, TH/BSO and PPALND recommended, followed by pelvic EBRT and VBT Chemo: must be discussed Stage IV (Bowel/bladder) Pelvic EBRT with BT Chemo: can be considered If RT fails, pelvic exenteration can be considered Stage IV (Distant mets, including intra-abdominal or inguinal nodes) Cytoreductive surgery only for operable peritoneal carcinosis Chemo: recommended Hormone therapy: recommended for ER+ RT: pelvic EBRT recommended to primary tumor If inguinal LN, additional lymphadenectomy recommended Brachytherapy ABS: American Brachytherapy Society 2012: Vaginal cuff 22265439 -- "American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy." Note: also includes indications for vaginal cuff irradiation for cervical cancer