The role of radiotherapy in the treatment of endometrial carcinoma

The role of radiotherapy (RT) in the treatment of endometrial cancer is based on the presence of the prognostic factors, tumor stage, histological grade, depth of myometrial invasion and age. Pelvic RT is indicated in stage I endometrial carcinoma in the presence of at least 2 of 3 risk factors: deep myometrial invasion (50% or more of the myometrial width), grade 3 histology, and age 60 or over. Three randomized trials have shown that pelvic RT provides a highly significant improvement of local control, but without a survival advantage. The use of RT should be limited to those patients at sufficiently high risk of locoregional recurrence (15% or over) to warrant the risk of treatment associated morbidity in order to maximize initial local control and relapse-free survival. The ongoing PORTEC-2 trial randomizes between vaginal brachytherapy and external beam RT to evaluate vaginal control, survival, side effects and quality of life. For high risk and advanced disease, pelvic RT continues to be the most effective adjuvant treatment to ensure pelvic control. Further trials on the efficacy of concurrent RT and chemotherapy are needed.