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Managementofendometrialcarcinoma PDF
Managementofendometrialcarcinoma PDF
ENDOMETRIAL CARCINOMA
INDICATIONS-
1. Deeply invasive tumors(stage IC)
2. Poorly differentiated histologies
3. Pathological stage IIB in absence of ESS
4. LVSI present.
RADIATION TECHNIQUE
• POSITION-supine
Immobilization
• 4 field box technique is used in conventional method
• Field borders – AP/PA
Superior – top of L5
Inferior – below obturator foramen
Lateral – 2 cm lateral to bony pelvis
• Lateral field:
Superior & inferior same
Anterior- Ant. To Symph. Pubis
Posterior – S2-S3 junction
Dose:- 45 - 50 Gy (1.8 Gy. – 2 Gy. / #)
• IMRT technique
• Imobilisation
• CT simulation (2.5 -5 mm slice) from upper border of
L5 to lower border of lesser trochanter)
• Target vol. delineation- GTV includes entire
uterus and cervix,vaginal extension as well as any
gross regional lymphadenopathy.
CTV includes the GTV as well as pelvic
lymphnode areas i.e. obturator,external and
internal iliacs as well as common iliacs.
PTV=CTV+ 1cm
POST OPERATIVE INTRACAVITARY
BRACHYTHERAPY
• ADVANTAGES-
a) LOWER MORBIDITY
b) PATIENT CONVINIECE
c) LOWER COSTS
DISADVANTAGES-
It does not address the pelvis and therefore
should be limited to patients in whom the pelvic
recurrence rate is estimated to be low.
• Predictors of vaginal relapse are grade 3 tumors
and presence of LVSI(in MAYO clinic series)
• Dose – 60-70Gy to the mucosal surface by LDR
in 72 hrs.
• Dose of HDR brachytherapy as recommended
by American Brachytherapy Society.
• Suggested dose for brachytherapy used alone
as adjuvant therapy in ca endometrium
NO OF HDR FRACTIONS DOSE/# DOSE –specific point
3 7.0 0.5 cm depth
4 5.5 0.5 cm depth
5 4.7 0.5 cm depth
3 10.5 Vaginal surface
4 8.8 Vaginal surface
5 7.5 Vaginal surface
• Suggested dose of brachytherapy when used
with 45Gy EBRT
3 4 0.5cm depth
2 8 Vaginal surface
3 6 Vaginal surface
CHEMOTHERAPY
• Role of chemotherapy in carcinoma
endometrium is limited to advanced disease
and in inoperable and recurrent disease.
• Commonly used agents are-
1. Cyclophosphamide
2. Anthracyclines
3. Platinums
4. Taxens
GOG 122 TRIAL
• N=396
• Stage III and IV
• After TAH+BSO+ESS <2cm residual tumour left
• Compared doxorubicin-cisplatin(AP) chemotherapy with
whole abdomen irradiation(30Gy in 20# AP/PA +boost to
pelvic/PA lymphnodes 15Gy in 8 #
• Doxorubicine-cisplatin every 3wk for 8 cycles
• 5yr PFS 38% for WAI Vs 50% in AP
• 5yr OS 42% for WAI Vs 55% in AP
• Recurrence after WAI was 54% Vs 50% in AP
• AP has more grade 3 hematological and gastrointestinal
toxicity than WAI.
• According to fleming et at addition of
Paclitaxel to AP in metastatic disease led to
improved response rates (34% to 57%),median
PFS(5.3 to 8.3 months) and median OS(12.3 to
15.3 months)
HORMONAL THERAPY-
1.used only in advanced and recurrent disease
2.Drugs-a.medroxyprogesterone
b. megestrol acetate
c. tamoxifen.
• Response occurs in 20 – 40% cases
• In a GOG randomised trial of low dose (200mg) Vs high
dose of oral daily medroxyprogesterone,there was no
advantage to higher dose.
• Use of progestins have been implicated in death due to
cardiovascular events hence their use in adjuvant
setting can not be supported
FOLLOW UP
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