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

Individualize

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

Results
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
LC 5y CSS
I 91 88
II 84 68

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-Share Alike 2.5 License.