Many Endometrial Ca Patients Get Unnecessary Radiation Post Surgery.
Dr. John Soper of Duke University Medical Center in Durham, N.C., maintained that many endometrial cancer patients could be spared the possible toxic effects of radiation treatment if their cancer was properly evaluated at the time of their hysterectomy.
But 70%-80% of patients with endometrial cancer are treated by general ob.gyns. who aren't trained to do the extensive staging required to determine whether radiation therapy is actually needed, he commented at the annual meeting of the Society of Gynecologic Oncologists.
"Historically, if full surgical staging is done with lymph node dissection, we find that only about 15%-20% of patients need additional radiotherapy, rather than the 70%-80% who are currently getting it," he told this newspaper.
Studies show that as many as 12% of patients who receive radiotherapy will have serious complications such as bowel obstructions or fistulas, which can result in death.
"The majority who receive whole pelvic radiation will get over the acute toxicity, but probably one in three women will have problems, sometimes even 20 years down the road when atherosclerosis or diabetes aggravates the radiation damage to the small vessels and the bowel and the bladder," Dr. Soper said at the meeting.
Before taking a patient to the operating room, general ob.gyns. can use MRI or spiral CT with contrast to determine the depth of the myometrial penetration and the involvement of the cervix.
"If you see a grade 1 endometrial cancer that is noninvasive, it's very appropriate to be managed by a generalist. But with a grade 2 or 3 cancer or with invasion into the inner myometrium, you're talking about patients with a risk of pelvic lymph node metastases between 5% and 10%. Unless that gynecologist has the resources to do a satisfactory lymphadenectomy, those patients should probably be referred to a gynecologic oncologist," he advised.
Debating the issue with Dr. Soper was Dr. Marcus Randall, who is a professor of radiation oncology at Indiana University in Indianapolis.
"What we need to be careful of is that we don't throw out the baby with the bathwater. We don't want to give the idea that hysterectomy with pelvic radiation is not the right treatment across the board. It might not be in the big medical center where the gynocologic oncologist can adequately stage the patient. But out in the community, where many patients aren't getting surgical staging, it may be that pelvic radiation is the best treatment for them," Dr. Randall said.
But Dr. Soper was not convinced by that argument. "We need to individualize therapy more than that. We can do better for women with endometrial cancer," he said.