Gyn Endometrial Special

Recurrent after Surgery Alone

  • EBRT + VB
  • 60 Gy to entire surface of vagina (dose to vaginal mucosa)
  • 75 Gy dosed to the tumor
    • for < 5 mm deep lesions vaginal cylinders (dosed to 5 mm depth)
    • for ≥ 5 mm deep lesions interstitial implant (dosed to tumor)
  • vaginal cuff – 40% AS 5yS with XRT
  • vagina with pelvic extenteration – 20% AS 5yS
  • Hormones used with 20% of pts. responding (progestin, tamoxifen)
  • Cispaltin and carboplatin based chemotherapy usually in combination with paclitaxel.

Medically Inoperable Early-Stage

  • MR to assess stage
  • Fletcher-Suit with one or two tandems or Simon-Heyman Capsules in combination with vaginal ovoids
  • 70-75 Gy to point A with LDR
  • Add EBRT to 45 Gy where appropriate

Uterine Sarcoma

Need Nodal Dissection

  • mixed mullerian tumors of the uterus
  • endometrial stromal sarcoma

Do not Need Nodal Dissection

  • leiomyosarcoma

Adjuvant RT

  • RT in patients with increase locoregional recurrence.
  • high-grade tumor
  • positive noes
  • positive margins
  • gross residual disease


  • 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 total abdominal hysterectomy and bilateral salpingo-oophorectomy.


  • Whole Pelvis (5000 cGy at 170-180 cGy per fraction) and ovoids (4500-5000 cGy surface dose to vagina).
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