Marnitz, S., Koehler, C., Gharbi, N., Kunze, S., Jablonska, K. and Herter, J. (2018). Evolution of adjuvant treatment in endometrial cancer-no evidence and new questions? Strahlenther. Onkol., 194 (11). S. 965 - 975. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-099X

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Abstract

Purpose For endometrial cancer (EC), clinical and pathological risk factors are taken to triage patients and estimate their prognosis. Lymph node involvement (pN+), lymphovascular space involvement (LSVI), grading, age of the patients, and T classification are internationally accepted parameters for treatment decisions. Materials and methods Studies on adjuvant radiation, chemotherapy, and chemoradiation are discussed against the background of risk stratification and clinical decision-making in early-to-advanced stage endometrial cancer. Recent publications on adjuvant treatment in high-risk disease and its implications for the patients with regard to expected oncologic benefit and treatment-related toxicity are discussed. Results Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI >= 50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment. Summary and perspectives In the future, integrated genomic characterization of tumors might be helpful for treatment individualization in the adjuvant setting.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Marnitz, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koehler, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gharbi, N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kunze, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jablonska, K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Herter, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-167363
DOI: 10.1007/s00066-018-1339-6
Journal or Publication Title: Strahlenther. Onkol.
Volume: 194
Number: 11
Page Range: S. 965 - 975
Date: 2018
Publisher: SPRINGER HEIDELBERG
Place of Publication: HEIDELBERG
ISSN: 1439-099X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
QUALITY-OF-LIFE; PHASE-III TRIAL; STAGE-I; PELVIC RADIOTHERAPY; POSTOPERATIVE RADIOTHERAPY; VAGINAL IRRADIATION; OPEN-LABEL; CARCINOMA; RISK; CHEMOTHERAPYMultiple languages
Oncology; Radiology, Nuclear Medicine & Medical ImagingMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/16736

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