Counterpoint: The role of adjuvant radiation in endometrial cancer. Inside, outside, or not at all?

摘要

Following surgery for endometrial cancer, patients may be advised to receive adjuvant radiation with or without chemotherapy. Historically, many patients were routinely given adjuvant radiation without any real evidence base or rational policies. More recently, we have seen evidence-based practice that has taken into account important contemporary clinical trials, including the Postoperative Radiation Therapy for Endometrial Carcinoma-1 (POR-TEC-1), A Study in the Treatment of Endometrial Cancer, (ASTEC), and Gynecologic Oncology Group 99 (GOG 99), which compared adjuvant postoperative radiation with no radiation (1-4), studies from Japan and Italy where chemotherapy was compared with radiation (5, 6), and the Nordic Society for Gynecologic Oncology/European Organisation for Research and Treatment of Cancer study of radiation vs. sequential chemoradiotherapy (7). In many of these studies, except GOG 99, the surgery did not routinely include pelvic lymph node dissection; the staging information from this is valuable even if we argue about the therapeutic benefit.