The use of a combination of external-beam radiation therapy and brachytherapy (radioactive implants) may offer promise for women with endometrial cancer that has recurred in the area of the uterus (or local recurrence), according to Canadian researchers. Their recently published report shows that this treatment regimen resulted in a cure for more than half of those treated.

Cancer of the endometrium is characterized by the presence of cancer cells in the lining of the uterus, or womb. Treatment options depend on many factors, including the type, grade, and stage (extent of disease at diagnosis) of disease. For stage I to III endometrial cancers, the standard primary treatment often consists of surgery to remove the uterus (called total abdominal hysterectomy) as well as the ovaries and fallopian tubes (called bilateral salpingo-oophorectomy). According to statistics, the 5-year survival rate for women who undergo surgery for endometrial cancer is about 82%. To help prevent a recurrence (return) of cancer, some women may also receive radiation therapy or chemotherapy after surgery (called adjuvant therapy). Despite this aggressive treatment, some women will experience a recurrence of cancer after therapy. Researchers continue to develop and study new and hopefully more effective treatment strategies for women who have recurrent endometrial cancer. Recently, Canadian researchers studied the use of radical radiation therapy, consisting of a combination of external-beam radiation therapy (radiation directed at the cancer from an external machine) and brachytherapy (placement of radioactive implants in or near the cancer).

Researchers in Toronto treated 58 women with endometrial cancer that recurred in the area of the uterus, none of whom had received prior radiation therapy. The average time from their initial surgery to the cancer recurrence was more than 1 year. All the women underwent radical radiation therapy, which consisted of a combination of external-beam radiation therapy to the uterus area and brachytherapy in most. After 5 years, 53% of the patients were alive; after 10 years, 41% were alive. Overall, survival was better in women who had early-stage disease at diagnosis, smaller cancers at recurrence, and/or lower grade (well differentiated cells under a microscope) disease.

These researchers concluded that more than half of women with locally recurrent endometrial cancer can be cured, and recommended that women with this type of disease be offered aggressive treatment. Persons who have recurrent endometrial cancer may wish to talk with their doctor about the risks and benefits of participating in a clinical trial (research study) in which brachytherapy/radiation therapy or another promising new therapy is being studied.

(Gynecologic Oncology, Vol 77, No 1, pp 66-72, 2000).