Adjuvant treatment for endometrial cancer: Literature review and recommendations by the Comite de l'evolution des pratiques en oncologie (CEPO)

作者：Morneau Melanie; Foster William; Lalancette Marc; Thu Van Nguyen Huynh; Renaud Marie Claude; Samouelian Vanessa; Letarte Nathalie; Almanric Karine; Boily Gino; Bouchard Philippe; Boulanger Jim; Cournoyer Ghislain; Couture Felix; Gervais Normand; Goulet Stephanie; Guay Marie Pascale; Kavanagh Melanie; Lemieux Julie; Lesperance Bernard; Letarte Nathalie; Morneau Melanie; Ouellet Jean Francois; Pineau Gilles; Rajan Raghu; Roy Isabelle; Samson Benoit; Sideris Lucas

来源：Gynecologic Oncology, 2013, 131(1): 231-240.

DOI：10.1016/j.ygyno.2013.07.084

• Cancer
• Endometrium
• Chemotherapy
• Radiotherapy
• Adjuvant

Objective. Despite the very good prognosis of endometrial cancer, a number of patients with localized disease relapse following surgery. Therefore, various adjuvant therapeutic approaches have been studied. The objective of this review is to evaluate the efficacy and safety of neoadjuvant and adjuvant therapies in patients with resectable endometrial cancer and to develop evidence-based recommendations.
Methods. A review of the scientific literature published between January 1990 and June 2012 was performed. The search was limited to published phase III clinical trials and meta-analyses evaluating the efficacy of neoadjuvant or adjuvant therapies in patients with endometrial carcinoma or carcinosarcoma. A total of 23 studies and five meta-analyses were identified.
Results. The selected literature showed that in patients with a low risk of recurrence, post-surgical observation is safe and recommended in most cases. There are several therapeutic modalities available for treatment of endometrial cancers with higher risk of recurrence, including vaginal brachytherapy, external beam radiotherapy, chemotherapy, or a combination of these.
Conclusions. Considering the evidence available to date, the CEPO recommends the following:
1) post-surgical observation for most patients with a low recurrence risk;
2) adjuvant vaginal brachytherapy for patients with an intermediate recurrence risk;
3) adjuvant pelvic radiotherapy with or without vaginal brachytherapy for patients with a high recurrence risk; addition of adjuvant chemotherapy may be considered as an option for selected patients (excellent functional status, no significant co-morbidities, poor prognostic factors);
4) adjuvant chemotherapy and pelvic radiotherapy with or without brachytherapy and para-aortic irradiation for patients with advanced disease;
5) hormonal therapy is not recommended in the adjuvant setting.

• 出版日期2013-10