Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

Abstract

Clinical practice guidelines for gynecologic cancers have been developed by many organizations. Although these guidelines have much in common in terms of the practice of standard of care for uterine corpus cancer, practice guidelines that reflect the characteristics of patients and healthcare and insurance systems are needed for each country. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to produce the third edition of the guidelines as an advanced form based on evidence-based medicine, considering up-to-date clinical trials and abundant qualified Korean data. These guidelines cover screening, surgery, adjuvant treatment, and advanced and recurrent disease with respect to endometrial carcinoma and uterine sarcoma. The committee members and many gynecologic oncologists derived key questions from the discussion, and a number of relevant scientific literatures were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, together with other details. The objective of these practice guidelines is to establish standard policies on issues in clinical areas related to the management of uterine corpus cancer based on the findings in published papers to date and the consensus of experts as a KSGO Consensus Statement.

Uterine sarcoma: a clinical case and a literature review

“…Preoperative diagnosis is essential for characterisation of uterine tumours to determine the safest therapeutic strategy. Minimally invasive techniques, including laparoscopic intervention, morcellation, myomectomy, and uterine artery embolization have been developed for the treatment of uterine leiomyoma and are not appropriate for the treatment of uterine sarcoma to prevent dissemination (27,28). In retrospective analysis it was found that women with LMS, who underwent morcellation, had an almost a three-times increased risk of a recurrent disease and worse overall survival regarding disease dissemination compared with the patients who underwent total abdominal hysterectomy and tumour consistency was not damaged (29,30).…”

“…If the uterine sarcoma is diagnosed through endometrium biopsy or myomectomy, additional surgery should be recommended to evaluate the disease extension and operability through an imaging work-up. Then standard surgical treatment is TAH with or without bilateral salpingo-oophorectomy and resection of metastatic lesions (28). For inoperable patients, pelvic radiotherapy with or without brachytherapy and/ or chemotherapy is given and hormonal therapy can be considered.…”

Assessing the effect of guideline introduction on clinical practice and outcome in patients with endometrial cancer in Japan: a project of the Japan Society of Gynecologic Oncology (JSGO) guideline evaluation committee

“…The trend of adjuvant therapy is another interesting issue. In contrast to the guidelines in other countries, which are based more on adjuvant radiation therapy [ 27 28 29 30 ], our guideline emphasizes on the benefits of adjuvant chemotherapy. The results of this study revealed that adjuvant therapies have been integrated into chemotherapy as recommended in the guideline.…”

Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study

“…Each guideline proposes specific criteria for the low-risk group, based on various combinations of preoperative histology and MRI parameters. In addition, decisions about fertility-sparing therapies are solely dependent on clinical staging, based on preoperative assessment [ 4 , 12 ]. However, the actual risk of extra-uterine disease in patients that satisfy the above-mentioned criteria has not yet been determined in diverse clinical settings.…”