Last Modified: 06/14/2013
Changes to This Summary (06/14/2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Endometrial Cancer
Revised text to state that cancer of the endometrium is the most common gynecologic malignancy in the United States, and irregular vaginal bleeding is an early sign and foremost symptom of the highly curable endometrial tumor.
Revised text to state that although the collection of cytology specimen is still suggested, a positive result does not upstage the disease.
Stage Information for Endometrial Cancer
Added text to state that Féderation Internationale de Gynécologie et d’Obstétrique stages are further subdivided by the histologic grade of the tumor, for example, stage IC G2.
Added text to state that the results of a study by the Danish Endometrial Cancer Group also suggest that the absence of radiation does not improve the survival of patients with stage I, intermediate-risk disease (cited Bertelsen et al. as reference 4).
Revised text to state that vaginal cuff brachytherapy is associated with less radiation-related morbidity than is external-beam radiation therapy (EBRT) and has been shown to be equivalent to EBRT in the adjuvant setting for patients with stage I disease (cited Nout et al. as reference 5). A subset of patients with stage I disease are at a high risk of recurrence and are eligible for adjuvant therapy; however, most patients will do well with surgery alone.
Added text to state that results of a study by the Danish Endometrial Cancer Group also suggest that the absence of radiation does not improve the survival of patients with stage I, intermediate-risk disease (cited Bertelsen et al. as reference 9).
Added text to state that the PORTEC-2 trial randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo vaginal brachytherapy (VBT) or EBRT, with prevention of vaginal recurrence as the primary outcome. At 5 years, there was no difference in the rates of vaginal recurrence, locoregional recurrence, progression-free survival, or overall survival (OS), for VBT and EBRT, respectively; however, there were significantly fewer gastrointestinal toxic effects in the VBT group, making VBT the preferred option for adjuvant treatment in patients with stage I disease (cited Nout et al. as reference 10 and level of evidence 1iA).
Added text to state that patients with stage III endometrial cancer are treated with surgery, followed by chemotherapy, or radiation therapy, or both. In a trial conducted in a subset of patients with stage III or IV disease with residual tumors smaller than 2 cm and no parenchymal organ involvement, the use of the combination of cisplatin and doxorubicin resulted in improved OS compared with whole-abdominal radiation therapy (cited Randall et al. as reference 1 and level of evidence 1iiA).
Added text to state that a subsequent trial of paclitaxel with doxorubicin had an outcome similar to that of cisplatin with doxorubicin, and that the three-drug regimen with granulocyte colony-stimulating factor (G-CSF) was significantly superior to cisplatin plus doxorubicin (cited Fleming et al. [Journal of Clinical Oncology 2004] as reference 2 and Fleming et al. [Annals of Oncology 2004] as reference 3 and level of evidence 1iiDiv).
Added text to state that several observational studies (cited Arimoto et al. and Sovak et al. as references 4 and 5, respectively) and phase II studies (cited Hoskins et al., Pectasides et al., Nomura et al., and Dimopoulos et al. as references 6, 7, 8, and 9, respectively) suggested clinical activity with the combination of platinums and paclitaxel in endometrial cancer patients with measurable disease either following primary surgery or at recurrence. The Gynecologic Oncology Group's GOG-0209 trial compared the combination of doxorubicin, cisplatin, and paclitaxel (TAP) and G-CSF with carboplatin and paclitaxel; the interim results showed that carboplatin and paclitaxel is not inferior to TAP, lending credence to the use of carboplatin and paclitaxel as the standard for adjuvant treatment in stage III and IV disease.
Added text to state that patients with inoperable disease caused by tumor that extends to the pelvic wall may be treated with a combination of chemotherapy and radiation therapy, which is usually a combination of intracavitary radiation therapy and EBRT.
Added text to include the use of biological agents alone, or in combination with chemotherapy, as a treatment option under clinical evaluation.
Added text to state that observational studies support maximal cytoreductive surgery for patients with stage IV disease, although these conclusions need to be interpreted with care because of the small number of cases and likely selection bias.
Added text to state that when possible, patients with stage IV endometrial cancer are treated with surgery, followed by chemotherapy, or radiation therapy, or both. In a trial conducted in a subset of patients with stage III or IV disease with residual tumors smaller than 2 cm and no parenchymal organ involvement, the use of the combination of cisplatin and doxorubicin resulted in improved OS compared with whole-abdominal radiation therapy (cited Randall et al. as reference 1 and level of evidence 1iiA).
Added text to state that a subsequent trial of paclitaxel with doxorubicin had a similar outcome to cisplatin with doxorubicin, adding that the three-drug regimen with granulocyte colony-stimulating factor (G-CSF) was significantly superior to cisplatin plus doxorubicin (cited Fleming et al. [Journal of Clinical Oncology 2004] as reference 2 and Fleming et al. [Annals of Oncology 2004] as reference 3 and level of evidence 1iiDiv).
Added text to state that several observational studies (cited Arimoto et al. and Sovak et al. as references 4 and 5, respectively) and phase II studies (cited Hoskins et al., Pectasides et al., Nomura et al., and Dimopoulos et al. as references 6, 7, 8, and 9, respectively) suggested clinical activity with the combination of platinums and paclitaxel in endometrial cancer patients with measurable disease either following primary surgery or at recurrence. The Gynecologic Oncology Group's GOG-0209 trial compared the combination of doxorubicin, cisplatin, and paclitaxel (TAP) and G-CSF with carboplatin and paclitaxel; the interim results showed that carboplatin and paclitaxel is not inferior to TAP, lending credence to the use of carboplatin and paclitaxel as the standard for adjuvant treatment in stage III and IV disease.
Revised text to state that paclitaxel, in combination with platinums or as a single agent, also has significant activity.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.