Preoperative Treatment of Endometrial Cancer

Preoperative Guidelines

Stage I, Grade 2

Single preoperative tandem and ovoids (3500 mg-hr to uterus, 5000-6000 cGy surface dose to vagina) followed by TAH & BSO (2-4 days).
Consider addition of postoperative radiation therapy for  ½ myometrial penetration: 4500 cGy whole pelvis per fraction with sigmoid block for entire treatment or midline block on last 1000 cGy.

Stage I, Grade 1-2, Enlarged Uterus (>10 cm);

Stage I, Grade 3; Stage II, All Grades
Preop whole pelvis (4000 cGy at 180 cGy per fraction) and tandem and ovoids (2500 mg-hr to uterus, 4000-5000 cGy surface dose to vagina) followed by TAH & BSO (2-6 weeks).

Stage III and IV


RT Alone

  • Not by choice, avoid if possible by referring pt to academic gyne/onc surgeon. Treat similar to cervix except prescription not standardized.
  • EBRT 45Gy then 2 x 48 hour T&O to pt A dose 75-80.
  • Load implant 15-15-15 and back off ovoids unless cervix is involved.

Preoperative RT

Advantages: Tumor shrinkage prior to surgery
Decrease hypoxia
Decrease implant at surgery
Decreased small bowel in field

Bucy UF 1989: 266 pts, Stage I, II Preoperative XRT vs. postoperative RT showed no difference in LC, AS or complications
Grade, stage, depth of myometrial involvement, exogenous estrogen use was prognostic
I 91 88
II 84 68

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