The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American society for radiation oncology evidence-based guideline

Purpose: To present evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer. Methods and materials: Key clinical questions to be addressed in this evidence-based guideline on endometrial cancer were identified. A comprehensive literature review was performed to identify studies that included no adjuvant therapy, or pelvic radiation or vaginal brachytherapy with or without systemic chemotherapy. Outcomes included local control, survival rates, and overall assessment of quality of life. Results: Patients with grade 1 or 2 cancers with either no invasion or < 50% myometrial invasion (MI), especially when no other high risk features are present, can be safely observed after hysterectomy. Vaginal cuff brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence for patients with grade 1 or 2 cancers with ≥. 50% MI or grade 3 tumors with < 50% MI. Patients with grade 3 cancer with ≥. 50% MI or cervical stroma invasion may benefit from pelvic radiation to reduce the risk of pelvic recurrence. There is limited evidence for a benefit to vaginal cuff brachytherapy following pelvic radiation. Multimodality treatment is recommended for patients with positive nodes or involved uterine serosa, ovaries or fallopian tubes, vagina, bladder, or rectum. Conclusions: External beam and vaginal brachytherapy remain integral aspects of adjuvant therapy for endometrial cancer.