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Updates on adjuvant chemotherapy and radiation therapy for endometrial cancer

Cowan, Matthewa; Strauss, Jonathan B.b,c; Barber, Emma L.a,c; Matei, Danielaa,c

Current Opinion in Obstetrics and Gynecology: February 2019 - Volume 31 - Issue 1 - p 31–37
doi: 10.1097/GCO.0000000000000506
GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny

Purpose of review This article will provide an opinion on adjuvant treatment of stage I–III endometrial cancer based on existing and evolving evidence.

Recent findings For early-stage (I and II) intermediate risk endometrial cancer, vaginal brachytherapy reduces the risk of locoregional relapse. Recent studies have investigated the use of chemotherapy in early stage, high-risk patient population, but did not demonstrate a survival benefit. As such, chemotherapy is only recommended for selected patients at high risk for distant recurrence. On the other hand, for stage III disease, chemotherapy has a well established role. A landmark trial recently reported confirmed that chemoradiation improves recurrence-free survival compared with radiation alone in stage III endometrial cancer. However, in another randomized phase III trial, chemoradiotherapy was not superior to chemotherapy alone in this group, raising questions as to whether addition of radiation is necessary. Therefore, improved risk stratification using molecular markers in addition to traditional pathological criteria is critically needed to better predict the risk of local and systemic recurrence and to assist therapy decision-making.

Summary Endometrial cancer care is evolving and recent pivotal trials highlight the significance of chemotherapy to the treatment of stage III endometrial cancer and not to the approach for stage I and II cancer. The role of radiation therapy for stage III disease is raised into question.

aDepartment of Obstetrics and Gynecology

bDepartment of Radiation Oncology, Northwestern University Feinberg School of Medicine

cRobert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA

Correspondence to Daniela Matei, MD, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 303 East Superior Street, Lurie 4-107, Chicago, IL 60611, USA. Tel: +1 312 6950990; e-mail:

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