Management Of Endometrial Cancer


  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO), without ESS, followed by a more liberal use of postoperative radiotherapy (RT) based on uterine histopathologic parameters
  • Routine ESS followed by a more restricted use of postoperative RT.
    • Proponents of ESS emphasize that it can be accomplished with acceptable morbidity, facilitates more accurate identification of disease extent, may be therapeutic even in those without nodal metastases, and can be cost-saving in that adjuvant therapy is limited to patients who are expected to benefit.
  • ESS:
    • Vascular injuries
    • Deep vein thromboses
    • Pulmonary emboli
    • Lymphocysts are uncommon (<2%)
    • ESS followed by radiation is accompanied by a higher rate of chronic enteric morbidity, necessitating surgical correction, when compared with the rate seen following simple hysterectomy and pelvic RT.
    • Access to para-AO is difficult in obese patients
      • Maybe easier with panniculectomy1


  • ASTEC study failed to show survival benefit for routine nodal sampling
  • PORTEC —> Excellent result with post-op RT for intermediate results

Mature results from a study in endometrial carcinoma (ASTEC) trial are pending.

Improvements in median disease-free survival have been achieved in patients with advanced stage III and IV disease after maximal surgical cytoreduction efforts to achieve optimal debulking (24,35,104). In those with stage IIIC disease, complete resection of clinically involved nodes with no evidence of gross residual disease increased median survival from 8.8 to 37.5 months (24).

Adjuvant Radiation Therapy

Think about risk groups in Endometrial Ca.

  • Three randomized clinical trials, only one of which included surgical staging
  • Adjuvant ==> Improved locoregional tumor control & progression-free survival (PFS)
  • No improvement in OS

Risk factors to consider:

  • Age>60
  • Deep (outer, 50%) myometrial invasion
  • Grade 3
  • LVI(GOG)
  • If at least 2 of these risk factors with Adj RT ==> Local relapse from 21.7% to 7.5% (PORTEC)

In both GOG and PORTEC, 70% of recurrences were in vagina.

After recurrence —> salvage therapy successful in 50%

Toxicity from EBRT:

  • ~25%
    • Mostly grade 1–2 (68%) GI & GU
  • 2% grade 3–4
  • Chronic lymphedema: 5% in RT vs 2.5% no RT(+LN dissection)