Endometrial Cancer Treatment via Adjuvant Radiotherapy

Shayan Ahmed, Jamia Millia Islamia, New Delhi

Endometrial cancer (EC) is the most prevalent gynaecological cancer, with endometrioid adenocarcinoma accounting for the majority of cases. Surgical intervention is considered to be the most radical type of treatment. Therefore, adjuvant radiotherapy is advised for certain patient subgroups for endometrial cancer treatment. To remove microscopic disease in the locoregional area, radiation modality includes pelvic external beam radiotherapy (EBRT) to the pelvis and vaginal brachytherapy (VBT) to the vaginal cuff. The choice of adjuvant radiation modality is dependent on the patient’s risk profile. The best adjuvant radiation method for patients with stage I to II high-risk endometrioid cancer is still up for debate.

High-risk endometrial cancer is marked by a higher incidence of pelvic recurrence and distant metastases, both of which contribute to the group’s poor prognosis. For high-risk patients with stage I to II endometrioid adenocarcinoma, recent research compares the oncologic results of EBRT, EBRT+VBT, and VBT alone. 

VBT was successful in preventing vaginal stump recurrence, whereas pelvic radiotherapy allowed for treatment of both the vaginal and pelvic lymphatic drainage areas. In the EBRT+VBT group, overall survival was considerably improved. The survival results of the EBRT and EBRT+VBT regimens were not significantly different. For intermediate- or high-intermediate-risk patients, vaginal brachytherapy alone is presently indicated. The best adjuvant radiation modality for patients with high-risk endometrioid cancer following complete hysterectomy, bilateral salpingo-oophorectomy, and main lymphadenectomy was investigated in this new study. After pelvic radiotherapy, the vaginal recurrence incidence among profoundly myometrial invasive Grade 3 patients was just 5%. No evidence adding a vaginal cuff brachytherapy boost to pelvic radiation improved pelvic control or mortality in cervical involvement patients. The local-regional control rate of EBRT alone was satisfactory for high-risk individuals. The rate of pelvic and vaginal control, as well as overall survival, appeared to be unaffected by a VBT increase. However, whether external and internal irradiation should be paired is still up for discussion.

The results revealed that patients who received pelvic irradiation had a lower locoregional recurrence rate and a lower distant failure rate than those who had VBT alone. This explains the significance of EBRT in high-risk groups. Furthermore, like in previous trials, distant metastases were the leading cause of failure in this one. Chemotherapy may help with survival by eradicating systemic micro-metastases, particularly distant metastases. Chemotherapy, however, did not significantly enhance survival in this study. In terms of toxicity, all individuals withstood acute toxicity well. During the follow-up period following therapy, no adverse events of Grade 3 or higher were discovered. However, additional data is required, as well as randomized studies.

Also read: Increasing life expectancy in cancer patients

Source: Wang, W., Zou, L., Wang, T., Liu, Z., He, J., Sun, X., Zhong, W., Zhao, F., Li, X., Li, S., Zhu, H., Ma, Z., Sun, S., Jin, M., Zhang, F., Hou, X., Wei, L., & Hu, K. (2021). Treatment optimization of pelvic external beam radiation and/or vaginal brachytherapy for patients with stage I to II high-risk Endometrioid adenocarcinoma: a retrospective multi-institutional analysis. BMC cancer, 21(1), 774. https://doi.org/10.1186/s12885-021-08524-x 

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About Author: Shayan Ahmed is currently pursuing a Master of Science degree in Microbiology from the Department of Biosciences, Jamia Millia Islamia, New Delhi. His area of research interest lies in antibiotic resistance and associated molecular mechanisms. His recent work was focused on understanding colistin resistance patterns in the environment, particularly in water bodies.