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Endometrial Cancer ASTRO Refresher 2022 - Coggle Diagram

- - - - Staging
        
        SoC is TH/BSO
        
        Lymphadenectomy is controversial
        
        :+1:NCCN recommends for uterine confined disease
        
        :-1:2 RCT found no survival benefit in early stage EC
        
        :-1:Cochrane found no decreased risk of death or recurrence vs. no LND
        
        LND
        
        consider in tumors >50% MMI, G3 or nonendometrioid
        NCCN
        
        LND w/ or w/o PA dissection is important prognostically
        ESTRO
        
        do not recommend LN for low grade/low risk but reserve for medium or high risk.
        
        Histopath Grades
        
        Grade 1
        
        ≤5% solid growth
        
        Grade 2
        
        6-50% solid growth
        
        Grade 3
        
        > 50% solid growth
- - - - LN eval is part of SoC: SLNB -→ PLND (boards answer)
        
        5 vessel LVSI: discuss EBRT
        w/ >50% MMI, probably EBRT
        
        VBT Rx
        dose
        Cylinder
        Length
        
        EBRT:
        Draw a CTV
        include...
        then expand 7mm
        then draw vagina parametria
        create ITV full empty bladder
        Treat IMRT
        Fracture risk increases >50 Gy, so 50.4Gy.
        Positive LN: common LN
        PA: only include if involved
        Presacral: cervical stromal
        Bladder dose is hard to constrain
        V30 <80%
        Small bowel V55 < 15cc
        
        Vaginal recurrence
        now systemics are first line
        EBRT + VBT if never got VBT
        EBRT if prior VBT