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Endometrial Cancer > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

What are the unfavorable histologies of endometrial cancer?

A

Papillary serous and clear cell

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2
Q

FIGO Stage I

A

IA: Tumor localized to endometrium or invades less than one-half of the myometrium IB: Tumor localized to endometrium one-half or more of the myometrium

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3
Q

FIGO Stage II

A

Tumor invades stromal connective tissue of the cervix but does not extend beyond uterus

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4
Q

FIGO IIIA

A

Tumor involves serosa and/or adnexa (direct extension or metastasis)

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5
Q

FIGO Stage IIIB

A

Vaginal involvement (direct extension or metastasis)

parametrial invasion

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6
Q

FIGO IIIC

A
  1. Regional pelvic nodal disease 2. Regional paraaortic nodal disease
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7
Q

FIGO Stage IVA

A

Tumor invades bladder mucosa and/or bowel mucosa (bullous edema does not qualify)

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8
Q

Stage IVB

A

Distant metastasis including metastasis to inguinal nodes, intraperitoneal disease, lung, liver or bone. (Excludes paraaortic lymph nodes, vagina, pelvic serosa or adexa)

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9
Q

AJCC Nodal stage to FIGO

A

N1: IIIC1

N2: IIIC2

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10
Q

AJCC T stage to FIGO

A

T1a and T1b: FIGO IA and IB

T2: FIGO II

T3a and T3B: FIGO IIIA and IIIB

T4: FIGO IVA

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11
Q

What are the poor prognostic signs?

A

High grade 2-3 Cervix involvement LVSI Age > 60 Deep myometrial invasion

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12
Q

What did the creasman data show is the risk for nodes if you have Deep 1/3rd endometrial wall invasion and you are Grade 1,2,3?

A

G1: 6%

G2: 14%

G3: 23%

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13
Q

What is the risk for pelvic and paraaortic nodes with Stage II disease?

A

Pelvic: 30%

Paraaortic: 15%

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14
Q

What imaging and labs are needed at diagnosis?

A

Imaging:

Transvaginal US

CXR

CT scan of abdomen and pelvis

Labs: CBC, BMP, LFTs, CA-125

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15
Q

What special studies are needed for advanced cases?

A

Cystoscopy and sigmoidoscopy

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16
Q

How do you treat Stage IA Grade 1-2 disease?

A

Extrafascial hysterectomy

Peritoneal cytology

Pelvic and paraaortic node sampling

No adjuvant treatment

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17
Q

How do you treat Stage IA grade 3 or IB Grade 1-2?

A

Vaginal brachytherapy alone

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18
Q

Treatment for Stage IB Grade 3 to II

A

TAH/BSO

pelvic cytology

PLND + paraaortic sampling

  1. EBRT
  2. +Vaginal brachytherapy for Stage II
19
Q

Stage III treatment options

A

TAH/BSO

pelvic cytology

PLND + paraaortic sampling

  1. Chemotherapy alone
  2. RT alone: pelvis + PA +/- vaginal cuff RT
  3. Chemo+ RT + chemo (sandwich chemo)
  4. Concurrent chemoradiation
  5. EBRT + concurrent cisplatin then carbo/taxol x 4 cycles
20
Q

Treatment options for Stage IV disease

A

If Grade 1-2 and ER/PR+: Megace

21
Q

Treatment for Papillary serous or Clear cell

A
  1. Surgery:

TAH/BSO and PAN dissection,

omentectomy

pelvic cytology

  1. Chemo (cisplatin and doxorubicin)
  2. Pelvic RT + Vaginal brachytherapy
22
Q

What chemotherapy is usually used in sandwich chemo?

A

Carboplatin and taxol x 6 cycles

23
Q

Small bowel Dose contraints

A

Small bowel V40 < 30%

24
Q

CT simulation

A

Supine

IV contrast

Small bowel contrast

Indexed bag

Mark vaginal cuff

Scan with bladder full, then rescan with empty

Fuse scans together to create ITV

25
IMRT Volumes
Superior: L4-5 at the bifurcation of the aorta Include the external iliac, internal iliac and common iliacs Include the presacral nodes if the tumor involves the cervix Use a 7 mm expansion around the vessels coming off bone, bowel and muscle Connect Nodal volumes with sacral volume and its inferior border is S3 PTV = 7 mm + CTV
26
Vaginal/Parametrial ITV volume
Superior border of CTV: When you see tissue between bladder and rectum Inferior border: Include 3 cm of vaginal cuff- usually to mid pubis Lateral: edge of nodal CTV of obturator Anterior: Include 1 cm rim of bladder Posterior border: curve around the rectum
27
What doses to you use when you combine EBRT with brachytherapy?
45 Gy at 1.8 Gy/fx 5 Gy x 3 with vaginal cylinder HDR. Precribe to 5 mm from vaginal surface and separate by 1 week each.
28
What RT dose do you use with HDR brachytherapy alone?
5.5 Gy x 4 fractions. Prescribe to 5 mm from vaginal surface. Separate by 1 week.
29
What RT dose with pelvic RT alone?
50.4 Gy at 1.8 Gy/fx
30
Dose constraints for vagina?
Upper vaginal mucosa: 150 Gy Midvaginal mucosa: 80-90 Gy Lower vaginal mucosa: 60-70 Gy
31
Acute complications of RT?
1. Frequent and urgent urination 2. Diarrhea
32
Late complications of RT?
1. Vaginal stenosis 2. Second cancers 3. Rectal bleeding 4. Hematuria 5. SBO
33
Bladder dose constraints?
V45\<35%
34
Rectum dose constraints
V30\<60%
35
Femoral head constraint?
V30\<15%
36
5 year OS for papillary serous and clear cell histologies?
5 year OS: 50%
37
What study supports VB alone for patients with high intermediate risk disease?
PORTEC 2 1) Pelvic RT to 46 Gy vs. 2) Vaginal brachytherapy 7 Gy x 3 or 30 Gy of LDR 5 year risk of pelvic recurrence was 0.5% vs. 3.8%, p=0.02 5 year vaginal recurrence rate was 1.6% vs. 1.8% 5 year OS was 79.6% vs. 84.8%, p=0.57
38
What is the 5 year OS for patients with Stage III disease?
40-70%
39
What is the 5 year OS for patients with Stage IV?
5 year OS is 0-10%
40
What study supports the use of EBRT for patients with high intermediate risk disease?
ASTEC/NCIC: EBRT +/- VB vs. OBS: 3% improvement in locoregional control. No difference in OS. GOG 99: EBRT vs. OBS (Low and Int): Lower recurrence improved in the high intermediate group only Aalders: EBRT+/- VB vs. OBS (Low and Int): Lower recurrence only in IC grade 3 PORTEC 1: EBRT vs. OBS: Lower recurrence with EBRT
41
Treat with bladder full or empty?
Full
42
What is the typical length of vaginal cuff treated with a vaginal cylinder?
4 cm
43
PTV margin
CTV + 7 mm

Endometrial Cancer (1 decks)

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