Dr Dzhugashvili speaks with ecancer at the 10th BGICC in Cairo about treatment guidelines for women with endometrial cancer.
She outlines treatment sequencing and stratification, leading with surgery followed by adjuvant treatments, depending on the patients risk profile.
Dr Dzhugashvili highlights when vaginal brachytherapy is recommended, and also discusses the PORTEC4 trial investigating genomic factors in endometrial cancer.
Endometrial cancer is the second most frequent cancer in the female population after breast cancer so the treatment of all the types of endometrial cancer in first line is surgery, radical surgery, which is a radical hysterectomy. After that is indicated adjuvant treatment. The indications for adjuvant treatment are according to study or risk factors. So risk factors are very important for the prescription of adequate adjuvant treatment because main randomised trials demonstrated that in early stage adenocarcinoma low risk is not indicated any adjuvant treatment because before they used a lot radiotherapy treatment, pelvic radiotherapy. But it was demonstrated that this type of treatment increased a lot toxicity and quality of life of the patients. The actual recommendation is for the early stage adenocarcinoma, stage 1a, the low risk, nothing, no adjuvant treatment.
What about the intermediate risk of endometrial carcinoma?
It's also very interesting because before also they applied radiotherapy or in some cases chemotherapy. But now it is demonstrated that in the intermediate risk adenocarcinoma the most used treatment is just vaginal brachytherapy. But it was conducted an interesting trial also by the Gynaecological Oncology Group, trial number 249, and the trial compared two types of treatment - vaginal brachytherapy plus chemotherapy and pelvic radiotherapy. This trial demonstrated that pelvic radiotherapy is more effective than vaginal brachytherapy plus chemotherapy but just in high risk adenocarcinoma but not in intermediate or low risk. So now actually the standard adjuvant treatment for endometrial carcinoma is the low risk nothing, just observation; intermediate risk consider observation or vaginal brachytherapy and high intermediate risk, according to stage, vaginal brachytherapy or pelvic radiotherapy plus chemotherapy. It depends on the risk factors and also the stage. In high risk adenocarcinoma the most useful treatment is pelvic radiotherapy but high risk endometrial carcinoma stage 3, including stage 3a, b, c, pelvic radiotherapy plus chemotherapy.
Are there any other upcoming trials?
Yes, but upcoming trials now is the PORTEC4 trial. This is an open trial but this trial will be conducted to investigate genomic specifications. For the next trials we will be determining the genomic characteristics of the endometrial carcinoma and the choice of any treatment regarding genomic characteristics and also the risk factors.
Have you had talks with other regional partners?
Yes, of course, because it's very important, the coordination between oncologists, medical oncologists, radiotherapy oncologists or also surgical oncologists. We always are together and analyse each patient and we choose the correct treatment for each patient individually.