Endometrial Cancer

Hypofractionation in radiotherapeutic management of endometrial cancer has an important but selective role in post-operative vaginal cuff HDR brachytherapy. SBRT is used for oligometastatic disease, rarely as a boost technique with EBRT and for palliation. These data have mostly been reported from retrospective cohorts that include other gynecological malignancies as discussed in the cervical cancer chapter. Surgery [total hysterectomy with bilateral salpingo-oophorectomy (BSO)] with or without nodal assessment (sentinel lymph node biopsy or nodal dissection) is the primary treatment of endometrial cancer. Recommendations for adjuvant radiotherapy are based on surgical pathology. Factors considered include depth of invasion, grade, lymphovascular space invasion, and nodal involvement. The use of postoperative vaginal cuff brachytherapy for high-intermediate risk early-stage endometrial cancer is increasing in recent years after reports indicating its efficacy in local control and favorable toxicity profile in comparison with pelvic EBRT. There is ongoing research assessing the efficacy and toxicity of hypofractionated pelvic EBRT; however, these fractionation strategies are not standardly used in clinical practice.