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    Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage I Endometrial Cancer

    Uterine serous histologies have higher rates of recurrence than do other stage I endometrioid carcinomas. The outcomes in institutional case series that utilize a policy of adjuvant carboplatin plus paclitaxel, occasionally including radiation therapy, for this histologic subtype, have been published and form the basis of management guidelines.[1,2,3,4,5,6,7] The Gynecologic Oncology Group (GOG-0249 [NCT00807768]) trial is comparing this chemotherapy regimen to pelvic radiation.

    Standard treatment options:

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    A total hysterectomy and bilateral salpingo-oophorectomy should be done if the tumor:

    • Is well or moderately differentiated.
    • Involves the upper 66% of the corpus.
    • Has negative peritoneal cytology.
    • Is without vascular space invasion.
    • Has less than a 50% myometrial invasion.

    Selected pelvic lymph nodes may be removed. If they are negative, no postoperative treatment is indicated. Postoperative treatment with a vaginal cylinder is advocated by some clinicians.[8]

    For all other cases and cell types, a pelvic and selective periaortic node sampling should be combined with the total hysterectomy and bilateral salpingo-oophorectomy, if there are no medical or technical contraindications. One study found that node dissection per se did not significantly add to the overall morbidity from hysterectomy.[9] While the radiation therapy will reduce the incidence of local and regional recurrence, improved survival has not been proven and toxic effects are worse.[10,11,12,13,14] Results of two randomized trials on the use of adjuvant radiation therapy in patients with stage I disease did not show improved survival but did show reduced locoregional recurrence (3%-4% vs. 12%-14% after 5-6 years' median follow-up, P <.001) with an increase in side effects.[13,15,16][Level of evidence: 1iiDii] Results of a study by the Danish Endometrial Cancer Group also suggest that the absence of radiation does not improve the survival of patients with stage I, intermediate-risk disease (grade 1 and 2 with >50% myometrial invasion or grade 3 with <50% myometrial invasion).[17]

    The PORTEC-2 (NCT00411138) trial randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo vaginal brachytherapy (VBT) or external-beam radiation therapy (EBRT), with prevention of vaginal recurrence as the primary outcome.[18] At 5 years, there was no difference in the rates of vaginal recurrence, locoregional recurrence, progression-free survival or overall survival (OS) (84.8% [95% confidence interval-CI-, 79.3-90.3] vs. 79.6% [95% CI, 71.2-88.0] for VBT and EBRT, respectively; P = .57). There were significantly fewer gastrointestinal toxic effects and significantly improved quality of life in the VBT group, making VBT the preferred option for adjuvant treatment of patients with stage I disease.[18,19][Level of evidence: 1iA]

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