｜｜International Medicel Center｜Site map｜old website

Update:2014/05/12

Endometrial cancer

Endometrial cancer is the most common malignancy of the female genital tract in Taiwan. More than 90% of cases occur in women older than 50 years of age. Most cases of endometrial cancer are diagnosed in early stages because of abnormal uterine bleeding as the presenting symptom in 90% of the cases.

Major prognostic factors for endometrial carcinoma are stage, age, histological type, grade, depth of myometrial invasion, and presence of lymph-vascular space invasion (LVSI). Adjuvant radiotherapy for endometrial carcinoma has increasingly been tailored to these risk factors. For low-risk endometrial cancer, standard treatment is surgery alone, with 95% probability of 5-year relapse-free survival. For intermediate-risk endometrial cancer, four large randomized trials have established the role of adjuvant external beam pelvic radiotherapy. Radiotherapy is regarded an essential treatment component for patients with high-risk or advanced-stage endometrial cancer. 

With the advance of radiotherapy technology in recent years, modern techniques including three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), RapidArc volumetric modulated arc therapy (VMAT), and image-guided radiotherapy (IGRT) enable precise radiation beam delivery to the target volumes and avoid unnecessary normal organ radiation exposure, and the side effects are remarkably reduced. However, there is still unpreventable substantial dose scattering to surrounding normal tissue by X-ray.

Proton beam has the Bragg peak which means a large amount of energy is released at the desired depth, but the entrance dose is low and no dose exists after the desired depth. There was little experience about proton treatment in gynecological malignancies because the uterus or cervix were mobile organ, which was difficult to be precisely irradiated by proton beam. However, there were emerging comparison study about treatment planning between proton beam and photon beam in the treatment of para-aortic region, which implies the potential role of proton to reduce bowel complication during extended field RT.

Article author: Dr. Yi-Ting Huang