Current Concepts in Radiation Therapy for Early-Stage Endometrial Cancer

Abstract

Purpose The present article aims to review current management for early-stage endometrioid carcinomas with a specific focus on adjuvant radiotherapy. Methods A comprehensive literature review was conducted regarding management of early-stage endometrioidtype endometrial cancers. Abstracted information included risk of relapse, treatment approach, and morbidity from treatment. Results A majority of low-risk patients are safely managed with observation, with vaginal cuff brachytherapy (VCBT) reserved for those with multiple other risk factors. Intermediate-risk patients are a heterogeneous group with a variable definition; previous trials have established that VCBT alone is suitable for most patients to avoid morbidity of pelvic external beam radiotherapy (EBRT). Highand high-intermediate risk patients warrant pelvic EBRT ± VCBT with or without sequential chemotherapy. Continued controversy exists regarding the optimal VCBT fractionation regimen, with suggestion that higher dose/ fraction regimens may lead to increased vaginal toxicity. Intensity-modulated radiotherapy is being investigated in an effort to reduce late toxicities. Advanced brachytherapy techniques such as image-guided brachytherapy have improved treatment of salvage and medically inoperable patients.Conclusions Identification of risk groups and toxicity reduction through either appropriate radiotherapy techniques or advanced techniques has enabled optimization of adjuvant management for early-stage endometrial cancer.