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Adjuvant postoperative radiation treatment for uterine cancer

General

Adjuvant radiation treatment is used for patients at high risk for pelvic tumor recurrence after an operation. 

Stage I

Endometrioid tumors in stage Ia-b grade 1–2 are categorized as low risk. It is not recommended to give adjuvant treatment to this patient group. 

Endometrioid tumors in stage Ic grade 1–2 as well as stage Ia-b grade 3 are considered moderate risk. The frequency of recurrence is about 10%. Recurrences are most frequently localized to the vagina or pelvis and can be treated with radiation therapy achieving good results (15). An effect on survival has not be found for adjuvant radiation therapy of these two patient groups (16). We do not recommend giving adjuvant treatment to this patient group.

Endometrioid tumors in stage Ic grade 3 are considered high risk having a risk for recurrence of about 25%. Recurrences are partly localized to the pelvis and partly outside the pelvis. Traditionally, adjuvant radiation therapy was given to this patient group, which reduced the frequency of local recurrence. It is still not clear whether this extends survival time (17). More recent studies have shown improved survival time with adjuvant chemotherapy instead of radiation treatment. For tumors remaining after treatment, consolidated radiation treatment may be considered. 

Serous papillary as well as clear cell tumors have a high risk for recurrence in both stage Ia, Ib and Ic. Radiation treatment to the pelvis reduces the risk for pelvic recurrences (18). Recurrences are, however, often localized outside the pelvis (18). Today adjuvant chemotherapy is given to this patient group instead of radiation therapy. Adjuvant treatment with progestagens has no documented effect in this group. 

Stage II

  • Stage IIa: Classified as stage I
  • Stage IIb: If a normal hysterectomy is performed, it is recommended to give external radiation therapy to a reduced pelvic field.

Stage III

  • Stage IIIa: The prognostic significance is debated for a positive cytology. There is no documentation on the effect of adjuvant treatment. 
  • If there are metastases to the adnexa or infiltration of the uterine wall, there is an increased risk for recurrence as much for tumor localized to the pelvis as outside. Traditionally, external radiation therapy to the pelvis has been given to these patients even though there is no documented effect on survival. Today, postoperative chemotherapy is given which is assumed to improve survival.  
  • Stage IIIb: Vaginal metastases are treated often with radition therapy combined with external and brachytherapy.
  • Stage IIIc: Patients with metastases to paraaortal lymph nodes are given chemotherapy if all tumor is removed, but not radiation treatment.

Indication

  • High risk for pelvic recurrence after the operation.

Goal

  • Cure the disease

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