The management of inoperable Stage I endometrial cancer using intracavitary brachytherapy alone: A 20-year institutional review

Shenfield, Carey B.; Pearcey, R.; Ghosh, Sunita; Dundas, George

doi:10.1016/j.brachy.2008.11.006

Cited by 21 publications

(6 citation statements)

References 24 publications

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“…Clinical complete radiologic response from MRI and 2-year locoregional control were achieved in 90% of the patients, with cancer-specific survival and OS rates of 86% and 97%, respectively [ 10 ]. Another study also reported a high success rate of treatment with low-dose rate ICRT using Heyman’s capsules in 44 cases of medically inoperable clinical stage I EMC [ 11 ], with 5-year disease-specific survival and OS rates of 88% and 61%, respectively. The authors concluded that low dose rate ICRT yielded outcomes similar to those of surgery and high dose rate ICRT.…”

Section: Resultsmentioning

confidence: 99%

Management of inoperable endometrial cancer

2022

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Some endometrial cancer (EMC) patients are not good candidates for primary surgery. The three major types of treatment for inoperable EMC are radiation therapy, chemotherapy, or their combination as neoadjuvant treatment before surgery. Radiation therapy alone (of different modes) has been used as the sole definitive therapeutic modality, particularly for early-stage disease that is limited to the uterine body and cervix with or without parametrial invasion. The most common treatment modality is neoadjuvant treatment before surgery. Postoperative adjuvant treatment is also occasionally used, depending mainly on the sites of the disease and the results of surgery. Data on neoadjuvant hormonal or radiation therapy are limited, with studies focusing on laboratory outcomes or having only a small number of patients. Most neoadjuvant treatments before surgery involved chemotherapy and fewer combined chemoradiotherapy. Surgery was generally performed, particularly in patients who had shown responses or at least stable disease to neoadjuvant treatment. Perioperative outcomes after neoadjuvant treatment were superior to those after primary surgery, whereas survival data were still inconsistent. Features that had or tended to have a favorable prognosis were younger age, early-stage disease, response to neoadjuvant treatment, low preoperative cancer antigen-125 level, and optimal surgery. Among different modalities of neoadjuvant treatment, which has become a frequent mode of treatment, neoadjuvant chemotherapy was more common than radiation therapy alone or chemoradiation.

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Section: Resultsmentioning

confidence: 99%

Management of inoperable endometrial cancer

2022

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“…Our findings add to previous literature supporting the utilization of radiation and hormonal therapy as an alternative in select populations with early endometrial cancer. Prior studies report a 5-year overall survival (OS) range of 39 to 71% following primary radiation therapy ( Potish et al, 1985b ; Varia et al, 1987b ; Shenfield et al, 2009b ). Most studies represent heterogeneous groups; and many, but not all patients were noted to be obese (BMI ≥ 30 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…As such, exploring alternative treatment options for this patient population is crucial, and radiation and hormonal therapy have often been utilized for non-surgical candidates. Several studies have investigated outcomes after radiation therapy alone in early endometrial cancer and it remains a viable option for local disease control in patients who cannot undergo surgery following an endometrial cancer diagnosis ( SGO Clinical Practice Endometrial Cancer Working Group et al, 2014 ; Potish et al, 1985a ; Varia et al, 1987a ; Shenfield et al, 2009a ).…”

Section: Introductionmentioning

confidence: 99%

Endometrial cancer in an increasingly obese population: Exploring alternative options when surgery may not cut it

Staples

Rauh

Peach

et al. 2018

Gynecologic Oncology Reports

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ObjectivesThe study objectives were to describe outcomes of obese patients with early endometrial cancer following primary non-surgical treatment, assess predictors of response, and estimate the increased surgical risk for these women.MethodsRetrospective chart review identified women with early stage endometrial cancer at a single institution with BMI ≥ 30 kg/m2 who did not undergo surgery as primary treatment modality due to obesity and medical co-morbidities. Clinicopathologic factors were abstracted, characteristics of responders vs. non-responders compared and the National Surgical Quality Improvement Program (NSQIP) surgical risk calculator utilized to quantify surgical risks.ResultsFifty-one patients were identified, with a mean BMI of 49.0 kg/m2. The NSQIP calculator predicted a significantly higher complication rate for our cohort compared to the expected average risk for hysterectomy (18.8% vs 7.2%, p < .0001). The majority of patients were treated with radiation alone (49%), followed by hormone therapy (45.1%). Response rates were 38.1% for women treated with hormones and 63.6% in the radiation group (p = .063). No significant differences were identified between responders and non-responders with regard to NSQIP scores, BMI, co-morbidities or age. Among those with persistent or progressive disease, 87.5% responded to secondary treatment. Only one death was from cancer progression. Two individuals died following treatment complications (one surgical, one chemotherapy); the remaining twelve deaths were due to pre-existing co-morbidities.ConclusionsHormone and radiation therapy are both viable options for obese patients deemed to have too significant risk of surgical complications. Pursuing surgical intervention in this population may do more harm than good.

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“…In this context, internists and anesthesiologists have a prominent role in assessing whether the patient is medically fit for surgery. Approximately 3–10% of EEC women are deemed inoperable [108,109]. EEC patients considered unsuitable for surgery can be treated with radiotherapy alone as the primary modality of treatment.…”

Section: Proposal Of a Management Algorithmmentioning

confidence: 99%

“…EEC patients considered unsuitable for surgery can be treated with radiotherapy alone as the primary modality of treatment. Radiotherapy techniques used have included various combinations of external beam radiotherapy (EBRT), high- or low-dose rate (HDR or LDR) uterine intracavitary brachytherapy, and HDR or LDR vaginal intracavitary brachytherapy [108,109]. Therefore, since radiotherapy alone becomes the only other curative alternative for medically inoperable EEC patients, the role of the radiation oncologist is very important in pretreatment counseling.…”

Section: Proposal Of a Management Algorithmmentioning

confidence: 99%

Surgical Management of Early Endometrial Cancer: An Update and Proposal of a Therapeutic Algorithm

et al. 2014

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In the last few years technical improvements have produced a dramatic shift from traditional open surgery towards a minimally invasive approach for the management of early endometrial cancer. Advancement in minimally invasive surgical approaches has allowed extensive staging procedures to be performed with significantly reduced patient morbidity. Debate is ongoing regarding the choice of a minimally invasive approach that has the most effective benefit for the patients, the surgeon, and the healthcare system as a whole.Surgical treatment of women with presumed early endometrial cancer should take into account the features of endometrial disease and the general surgical risk of the patient. Women with endometrial cancer are often aged, obese, and with cardiovascular and metabolic comorbidities that increase the risk of peri-operative complications, so it is important to tailor the extent and the radicalness of surgery in order to decrease morbidity and mortality potentially derivable from unnecessary procedures. In this regard women with negative nodes derive no benefit from unnecessary lymphadenectomy, but may develop short- and long-term morbidity related to this procedure. Preoperative and intraoperative techniques could be critical tools for tailoring the extent and the radicalness of surgery in the management of women with presumed early endometrial cancer. In this review we will discuss updates in surgical management of early endometrial cancer and also the role of preoperative and intraoperative evaluation of lymph node status in influencing surgical options, with the aim of proposing a management algorithm based on the literature and our experience.

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The management of inoperable Stage I endometrial cancer using intracavitary brachytherapy alone: A 20-year institutional review

Cited by 21 publications

References 24 publications

Management of inoperable endometrial cancer

Management of inoperable endometrial cancer

Endometrial cancer in an increasingly obese population: Exploring alternative options when surgery may not cut it

Surgical Management of Early Endometrial Cancer: An Update and Proposal of a Therapeutic Algorithm

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