Topic 11. Radiotherapy in the Treatment of Endometrial Cancer
Endometrial cancer is the most common gynecological malignancy in developed countries. The primary treatment is surgery, while radiotherapy is mainly used as adjuvant (postoperative) therapy to reduce local recurrence. In selected medically inoperable patients, radiotherapy may be used as definitive treatment.
Unlike cervical cancer, surgery is the cornerstone of treatment, and radiotherapy is usually an adjunct.
Role of Radiotherapy According to Stage
A. Early Stage (FIGO I)
Treatment of choice:
- Total hysterectomy
- Bilateral salpingo- oophorectomy (BSO)
Radiotherapy depends on recurrence risk.
Low- risk patients
- Surgery alone
- No radiotherapy required
Intermediate- risk patients
- Vaginal brachytherapy (VBT) is usually recommended.
High- intermediate or high- risk patients
- External Beam Radiotherapy (EBRT)
- Vaginal brachytherapy
- Chemotherapy may be added depending on pathology.
B. Locally Advanced Disease (FIGO II–III)
Treatment usually includes:
- Surgery
- Adjuvant EBRT
- Vaginal brachytherapy
- Chemotherapy in selected high- risk patients
Radiotherapy reduces pelvic recurrence and improves local control.
C. Stage IVA–IVB or Recurrent Disease
Radiotherapy is mainly palliative, although selected local recurrences may be treated with curative intent.
It is used to relieve:
- Vaginal bleeding
- Pelvic pain
- Bone pain
- Obstruction symptoms