Controversies in the Adjuvant Therapy of Endometrial Cancer

Sheng-Mou Hsiao,Lin-Hung Wei

doi:10.5402/2011/724649

Abstract

Endometrial cancer is the most common malignancy of the female genital tract. Surgical treatment includes hysterectomy, bilateral salpingo-oophorectomy, and an appropriate staging procedure. Relapse of endometrial cancer may occur in patients with high risk factors, such as old age, grade 3 cancer, deep myometrial invasion, and papillary serous and clear cell types. In recent years, several randomized trials reported the results of adjuvant therapy for patients with high risk factors. Nonetheless, some controversies still exist. This paper presents and discusses the results of important randomized trials of adjuvant therapy for endometrial cancer with risk factors.

Highlights

Endometrial cancer (EC) is the most common malignancy of the female genital tract in the Western world with an annual incidence of 15–18/100,000 women [1]
For better communication of the text below, the following descriptions of previous randomized trials are based on the International Federation of Gynecology and Obstetrics (FIGO) 1988 classification system instead of the FIGO 2009 staging system
It is noteworthy to understand that stage IA and stage IB of the FIGO 1988 staging system are merged as stage IA of FIGO 2009 staging system; stage IIA is merged with stage I; positive cytology has to be reported separately without changing the stage; stage IIIC is subdivided into stage IIIC1 and stage IIIC2 [2]

Summary

Introduction

Endometrial cancer (EC) is the most common malignancy of the female genital tract in the Western world with an annual incidence of 15–18/100,000 women [1]. IA, grade 1 (G1) or grade 2 (G2) and stage IB, G1 patients with no adverse prognostic factors [3]. Roper et al reported the major prognostic factors for early-stage EC to include older age, histologic type (i.e., serous or clear cell type), high histologic grade, deep myometrial invasion, lymphovascular space invasion (LVSI), large tumor size (>2 cm), and involvement of the lower uterine segment or cervix [4]. The Gynecologic Oncology Group (GOG) 99 trial [6] further defined highintermediate and low-intermediate risk groups from the GOG 33 [5]. High-intermediate risk is defined as: (1) at least 70 years of age with only one of the other risk factor (i.e., moderate to poorly differentiated tumor grade, presence of LVSI, and deep (>2/3) myometrial invasion), (2) at least 50. We attempt to discuss adjuvant therapy from the perspectives of different risk factor subgroups by analyzing the results of the randomized trials

Adjuvant Therapy for Low and Low-Intermediate Risk Groups of EC Patients

Adjuvant Therapy for the High-Intermediate Risk Group of EC Patients

Findings

Adjuvant Therapy for the High Risk Group of EC Patients