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Treatment for Early Stage Endometrial Cancer Hinge on Risk Factors in New Guidelines: Presented at NCCN

By Ed Susman

HOLLYWOOD, FL -- March 10, 2006 -- New guidelines for treatment of early stage endometrial cancer suggest that presence of risk factors can help in choosing the optimal adjuvant treatment.

"Adjuvant treatment when the disease is confined to the uterus is very controversial," said Benjamin Greer, MD, Professor and Director of Gynecologic Oncology, who presented the new algorithm for treatment here at the 11^th annual conference of the National Comprehensive Cancer Network (NCCN).

The new treatment guidelines replace the previous algorithm first developed for the 19-hospitals that make up the NCCN consortium in 2000.

Risk factors for poor outcome in endometrial cancer include prior endogenous estrogen exposure, obesity, anovulation, early menarche and late menopause, prior use of tamoxifen and diabetes or hypertension

In surgically confirmed stage I endometrial cancer, the decision on treatment is based on whether a woman has adverse risk factors and on the histological grade of the tumor, he said during a presentation on March 9^th.

For example, in stage IA cancer in a woman without adverse risk factors and grade 1 or grade 2 histology, the recommended treatment is observation. For tumors with grade 3 histology, clinicians have a choice of offering the patient observation or vaginal brachytherapy.

Women with adverse risk factors can be offered observation if the tumor is grade 1 or 2. If the tumor is grade 3, the clinician can offer observation, vaginal brachytherapy or pelvic radiotherapy; although there is little evidence to suggest that mode of treatment has any benefits.

In stage IB endometrial cancer, women without adverse risk factors and with grade 1 histology should be placed under observation; those with grade 2 or 3 histology should be offered observation or vaginal brachytherapy, Dr. Greer said.

In women with stage IB disease, the presence of adverse risk factors and grade 1 histology calls for vaginal brachytherapy; for grade 2 histology, the recommended treatment would be observation or either of the two treatments -- vaginal brachytherapy or pelvic radiotherapy; for grade 3 histology, observation is no longer recommended, so women should be offered pelvic radiotherapy and/or vaginal brachytherapy, he said.

Women with stage IC cancer without adverse risk factors, grade 1 or 2 tumors call for observation or vaginal brachytherapy; for grade 3 tumors, pelvic radiotherapy and/or vaginal brachytherapy is suggested.

In stage IC disease, the presence of adverse risk factors in women with grade 1, 2 or 3 tumors would call for pelvic radiotherapy and/or vaginal brachytherapy.


[Presentation title: Update: Cervical and Uterine Cancer Guidelines.]

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