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Endometrial Cancer Treatment Protocols 

  • Author: William T Creasman, MD; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
 
Updated: Nov 20, 2015
 
 

Treatment Protocols

Treatment protocols for endometrial cancer are provided below, including general treatment recommendations; recommendations for limited, metastatic, recurrent, and high-risk disease; and risk classifications.

General treatment recommendations for endometrial cancer

See the list below:

  • Endometrial cancer is treated primarily with surgery, including hysterectomy, bilateral salpingo-oophorectomy, abdominopelvic washings, lymph node evaluation; advanced disease patients may be treated with maximal surgical cytoreduction
  • There is no general agreement as to what constitutes the best chemotherapy, as very few phase III studies have been done comparing different chemotherapy regimens
  • There are no guidelines or recommendations for second- and third-line therapy
  • Salvage agents such as paclitaxel may be an option for second-line therapy in patients who have disease recurrence even after first-line chemotherapy
  • Participating in a phase II study is encouraged

Treatment recommendations for limited disease

See the list below:

  • Generally stage I endometrial cancer limited to the uterus, the recommended treatment is surgery[1]
  • Radiation therapy has proven to be effective and tolerated for patients that are not candidates for surgery whose disease is limited to the uterus
  • Patients with suspected or gross cervical involvement who are candidates for surgery should be recommended radical hysterectomy with bilateral salpingo-oophorectomy; cytology and dissection of pelvic and para-aortic lymph nodes and inoperable patients should be treated with radiation therapy (75-80Gy to point A)
  • Patients with suspected extra uterine disease should be evaluated through imaging studies (MRI or CT) or lab tests (CA 125 levels); if negative results return, treat patients as for disease limited to the uterus
  • Patients with extrauterine pelvic disease should be treated with radiation therapy and brachytherapy with or without surgery and chemotherapy

Risk classification for patients with endometrial cancer

Patients with endometrial cancer can be stratified into treatment groups based upon the estimated risk of disease recurrence[2] :

  • Low risk: endometrioid cancers that are confined to the endometrium
  • Intermediate risk: disease confined to the uterus but invades the myometrium, or demonstrates occult cervical stromal invasion; includes some patients with stage IA disease, stage IB disease, and a subset of patients with stage II disease
  • High risk: includes gross involvement of the cervix (a subset of stage II disease; stage III or IV disease, regardless of grade; papillary serous or clear cell uterine tumors

Postoperative adjuvant chemotherapy based on risk classification

See the list below:

  • Low risk to low-intermediate risk: There is no evidence showing adjuvant chemotherapy after surgery decreases risk of recurrent disease or death from low-risk or low-intermediate risk endometrial cancer; adjuvant therapy with chemotherapy or progestational agents is not recommended[1]
  • High-intermediate risk: Patients may benefit from postoperative adjuvant radiation therapy
  • High-risk: Adjuvant therapy is recommended for all patients including radiation therapy and chemotherapy

Chemotherapy recommendations for metastatic, recurrent, or high-risk disease

Single-agent therapy[1] :

Combination therapy[3] {ref46-INVALID REFERENCE}:

  • Doxorubicin 60 mg/m2 IV plus  cisplatin 50 mg/m2 IV on day 1; repeat every 21d or
  • Doxorubicin 45 mg/m2 IV plus  cisplatin 50 mg/m2 IV on day 1 plus  paclitaxel 160 mg/m2 over 3h on day 2; repeat every 21d or
  • Cisplatin 50 mg/m2 IV plus  doxorubicin 50 mg/m2 IV on day 1; repeat every 21 cycles or
  • Doxorubicin 45 mg/m2 IV on day 2 plus  cisplatin 50 mg/m2 IV on day 1 plus  paclitaxel 160 mg/m2 IV over 3h on day 2 plus filgrastim 5 μg/kg SC on days 3-12; regimen repeated every 21d or
  • Carboplatin AUC 5-7 IV plus  paclitaxel 175 mg/m2 IV over 3h on day 1[4]
 
Contributor Information and Disclosures
Author

William T Creasman, MD J Marion Sims Distinguished University Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina College of Medicine

William T Creasman, MD is a member of the following medical societies: North Carolina Medical Society, Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, South Carolina Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital

Disclosure: Nothing to disclose.

Chief Editor

from Memorial Sloan-Kettering - Yukio Sonoda, MD Associate Professor, Weill Cornell Medical College; Associate Attending Surgeon, Gynecology Service, Department of Surgery, Memorial Hospital for Cancer and Allied Diseases; Associate Member, Memorial Sloan-Kettering Cancer Center

from Memorial Sloan-Kettering - Yukio Sonoda, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, American Medical Association, Society of Gynecologic Oncology, Society of Laparoendoscopic Surgeons, AAGL, American Society of Clinical Oncology, International Gynecologic Cancer Society, Japanese Medical Society of America, Korean American Medical Assocation

Disclosure: Nothing to disclose.

References
  1. NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms. Available at http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed: March 28, 2011.

  2. Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Mar. 92(3):744. [Medline].

  3. Fleming GF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004 Jun 1. 22(11):2159-66. [Medline].

  4. Vergote I, Debruyne P, Kridelka F, Berteloot P, Amant F, Honhon B, et al. Phase II study of weekly paclitaxel/carboplatin in combination with prophylactic G-CSF in the treatment of gynecologic cancers: A study in 108 patients by the Belgian Gynaecological Oncology Group. Gynecol Oncol. 2015 Aug. 138 (2):278-84. [Medline].

  5. Hoskins PJ, Swenerton KD, Pike JA, et al. Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study. J Clin Oncol. 2001 Oct 15. 19(20):4048-53. [Medline].

  6. Nagao S, Nishio S, Okada S, Otsuki T, Fujiwara K, Tanabe H, et al. What is an appropriate second-line regimen for recurrent endometrial cancer? Ancillary analysis of the SGSG012/GOTIC004/Intergroup study. Cancer Chemother Pharmacol. 2015 Aug. 76 (2):335-42. [Medline].

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