Endometrial Cancer 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

• 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

• 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

• 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]:

• Cisplatin 50-100 mg/m² IV over 30min with vigorous hydration; repeat every 3wk or
• Carboplatin AUC 5-7 IV over 30min; repeat every 3wk or
• Paclitaxel 175 mg/m² IV over 3h; repeat every 3wk or
• Doxorubicin 60-75 mg/m² IV bolus; repeat every 3wk or
• Liposomal doxorubicin 50 mg/m² IV; repeat every 3-4wk

Combination therapy^{[3, 4]}:

• 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