News | Radiation Therapy | December 08, 2022

Update to 2014 guidance outlines best practices for patient-centered, multidisciplinary care

Update to 2014 guidance outlines best practices for patient-centered, multidisciplinary care

December 8, 2022 — A newly updated clinical guideline from the American Society for Radiation Oncology (ASTRO) provides recommendations on the use of radiation therapy and systemic therapy after surgery to treat patients with endometrial cancer. The guideline also considers the role of surgical staging and molecular profiling techniques in determining whether a patient should receive post-operative therapy. The guideline is published in the January/February 2023 issue of Practical Radiation Oncology.

Endometrial cancer is the most common type of gynecological cancer in the U.S., with more than 60,000 estimated new diagnoses each year. Standard treatment involves surgical removal of the patient’s uterus, cervix, fallopian tubes and ovaries, with additional post-operative therapy indicated for patients with risk factors for cancer recurrence.

“Since ASTRO published its original endometrial cancer guideline in 2014, multiple research teams have published high-quality clinical trials on the usefulness of post-operative therapy for patients with different disease stages and risk profiles,” said Beth A. Erickson, MD, FASTRO, chair of the guideline task force and a professor of radiation oncology at the Medical College of Wisconsin in Milwaukee.

“For patients with an elevated risk of recurrence following endometrial cancer surgery, clinical trials consistently show that adjuvant therapy can improve outcomes,” she said. “Our task force synthesized findings from these trials into recommendations for external beam radiation, brachytherapy and chemotherapy in the post-surgical setting, with a focus on multidisciplinary, patient-centered care.”

The guideline task force also considered new trials on the accuracy of surgical staging techniques and the increasing role of molecular profiling for endometrial tumors in guiding adjuvant therapy decisions. Matthew M. Harkenrider, MD, vice chair of the guideline task force and an associate professor of radiation oncology at Loyola University Chicago said, “Researchers have identified several potential biomarkers for endometrial cancer and are now exploring whether these molecular markers can help determine which patients will benefit from adjuvant therapy.”

The guideline includes treatment algorithms for stage I-II endometrial cancers, stage I-II cancers with high-risk histologies and stage III-IVA cancers. It details the recommended use of external beam radiation therapy (EBRT), vaginal brachytherapy (VBT) and chemotherapy for patients with different risk profiles, as well as which patients should not receive adjuvant therapy. Key recommendations are as follows:

  • Based on a patient’s clinical-pathologic risk factors, radiation therapy is recommended to reduce the risk of locoregional recurrence. The choice of EBRT versus VBT in FIGO stage I endometrial cancer should depend on lymph node assessment and uterine risk factors. EBRT is recommended for patients with stage I disease with high-risk features, stage II disease or stage III-IVA disease.
  • Systemic chemotherapy should be effectively sequenced with radiation therapy for patients with high-risk histologies and/or stage III-IVA disease to decrease the risk of distant and locoregional recurrence, respectively.
  • When EBRT is indicated, the use of intensity-modulated radiation therapy with daily image-guidance is associated with improved patient-reported outcomes and reduced side effects. Recommendations in the guideline also outline optimal radiation dosing, treatment planning and delivery techniques based on the patient’s cancer stage and histology.
  • For surgical nodal staging, sentinel lymph node mapping is recommended over pelvic lymphadenectomy, and the use of adjuvant therapy should be based on a patient's pathologic ultrastaging status.
  • Molecular tumor profiling is recommended and may be used to guide recommendations for adjuvant therapy.

About the Guideline

The guideline was based on a systematic literature review of articles published through August 2021. The multidisciplinary task force of subject matter experts included radiation oncologists, medical oncologists and gynecological oncologists, a medical physicist, a radiation oncology resident and a patient representative. The guideline was developed in collaboration with the American Brachytherapy Society, the American Society of Clinical Oncology and the Society of Gynecologic Oncology. It is endorsed by the Canadian Association of Radiation Oncology, European Society for Radiotherapy and Oncology, and the Royal Australian and New Zealand College of Radiologists.

The guideline also acknowledges the negative impact of systemic racial disparities on endometrial cancer outcomes. While the guideline is focused on the medical considerations for treatment, the task force also wanted to recognize the complex nature of access to care for underserved patient populations.

ASTRO's clinical guidelines are intended as tools to promote appropriately individualized, shared decision-making between physicians and patients. None should be construed as strict or superseding the appropriately informed and considered judgments of individual physicians and patients.

For more information: www.astro.org

 


Related Content

Feature | Radiology Imaging | By Melinda Taschetta-Millane

It's been a fruitful month for itnonline.com! Here's a look at what ITN viewers found to be most interesting during the ...

Time June 01, 2023
arrow
News | Radiation Oncology

May 31, 2023 — Elekta announced the launch of the first phase of Elekta ONE*, its most comprehensive and advanced ...

Time May 31, 2023
arrow
News | Radiation Therapy

May 30, 2023 — The first treatment, for a patient with prostate cancer, was successfully carried out on April 28. Yonsei ...

Time May 30, 2023
arrow
News | Oncology Information Management Systems (OIMS)

May 24, 2023 — RaySearch Laboratories AB announced that the oncology information system RayCare* (* subject to ...

Time May 24, 2023
arrow
News | ASTRO

May 23, 2023 — More than 9 in 10 radiation oncologists report that their practices face clinical staff shortages ...

Time May 23, 2023
arrow
News | Radiation Oncology

May 23, 2023 — ZAP Surgical Systems, Inc., a leading innovator in the field of surgical robotics, today announced that ...

Time May 23, 2023
arrow
News | Radiation Oncology

May 22, 2023 — Physicians and scientists from the UCLA Jonsson Comprehensive Cancer Center will discuss the latest ...

Time May 22, 2023
arrow
News | Radiation Oncology

May 18, 2023 — Cassling announced it is a new strategic sales agent in various geographic territories across the United ...

Time May 18, 2023
arrow
News | Radiation Oncology

May 16, 2023 — The American Society for Radiation Oncology (ASTRO) today expressed its strong support for President ...

Time May 16, 2023
arrow
News | Radiation Therapy

May 15, 2023 — GE HealthCare is presenting three new global innovations – Intelligent Radiation Therapy (iRT), Auto ...

Time May 15, 2023
arrow
Subscribe Now