Didactics-Adjuvant Therapy in Ealy Stage Endometrial Cancer

Video Transcription
Video Summary
In the video, the speaker discusses the management of early endometrial cancer and the use of adjuvant therapy. They highlight the goal of decreasing recurrence and improving survival while minimizing treatment toxicity. Patients at very low risk of recurrence, such as those with stage 1 grade 1 cancers without myometrial invasion or LVSI, are generally safe to be observed without adjuvant treatment. However, for intermediate risk patients, studies like PORTEC-1 and GOG-99 have shown that adjuvant radiation therapy can decrease recurrence rates, but without a significant impact on overall survival. Further analysis identified a subset of intermediate risk patients who benefited the most from radiation therapy. Another trial, PORTEC-2, examined the use of vaginal brachytherapy for high intermediate risk patients, finding it to be non-inferior to external beam radiation in terms of recurrence rates. However, some patients with higher risk of pelvic sidewall recurrence may still benefit more from external beam radiation. The potential use of external beam radiation therapy in patients with substantial lymphovascular space invasion (LVSI) is also discussed. Additionally, GOG-249 tested the combination of vaginal brachytherapy and chemotherapy as adjuvant treatment for high intermediate risk and high-risk early stage disease. However, this approach was not found to be superior to external beam radiation and was associated with more frequent and severe toxicity. The trial also had some limitations, including the inclusion of heterogeneous patient groups. Finally, PORTEC-3 evaluated the combination of pelvic radiation and chemotherapy versus radiation alone in high-risk early stage and stage 3 endometrial cancer patients. The updated survival analysis showed that the combination approach improved progression-free and overall survival, primarily among women with serous histology or stage 3 disease. The speaker concludes by summarizing the recommendations for different risk groups and treatment modalities, with observation for low-risk and low-intermediate risk patients, vaginal cuff brachytherapy for most high-intermediate risk patients, and a combination of external beam radiation and vaginal cuff brachytherapy for high-risk patients.
Asset Subtitle
Sarah Paraghamian
May 2020
Keywords
endometrial cancer
adjuvant therapy
recurrence
survival
treatment toxicity