Oncology
Endometrial Cancer
Radiation Therapy for Medically Inoperable Endometrial Cancer
Some patients with endometrial cancer are deemed medically inoperable due to factors such as advanced age and comorbidities that increase perioperative risk. For such patients, definitive radiation therapy is an option that can result in favorable local control and improved survival outcomes.
While we have made important advances in our surgical approaches, there is still going to be a small number of patients who cannot undergo surgery safely (eg, older patients with cardiovascular disease or perhaps an individual with very morbid obesity). For these patients, we tend to think about using primary radiation therapy.
Years ago, we used external beam radiation therapy (EBRT) with a four-field-box technique, but the radiation treatment area included a large region of normal tissue, and the clinical results were not very good with that approach. There have been many advancements since that time, including image-guided radiation therapy and image-guided brachytherapy. Today, imaging is routinely used to guide EBRT and brachytherapy, allowing for the development of tailored plans that reduce treatment-related toxicities. This approach provides the delivery of radiation to a cancer with better control over the dosimetry to normal structures around the uterus. As a result, primary radiation therapy has shown better results than ever before. For early endometrial cancers, favorable disease control rates can be achieved in these patients, which is not bad considering that there is no surgical removal of the primary tumor.
Studies showing the best results with primary radiation treatment in women with inoperable disease incorporate some sort of brachytherapy in addition to EBRT. By using the combination therapy modality, you can deliver a much higher dose of radiation in high proximity to the cancer but without having toxicity to surrounding urinary or intestinal structures.
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