Treatment Options for Stage I and Stage II Endometrial Cancer

Treatment of stage I and stage II endometrial cancer depends on the grade and histological type.

In the current Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) staging system, stage II describes tumor that invades the cervical stroma; this is equivalent to the prior stage IIB. Almost all randomized trials for early-stage cancer excluded stage IIB patients. As a result, there is a paucity of quality data on which to base clinical decisions for patients with stage II endometrial cancer.

Low-risk histology:

Grades 1 and 2 tumors are considered low-risk unless they have serous or clear cell histologies.

Treatment options for patients with low-risk histological subtypes of stage I endometrial cancer include:

Most patients do well with surgery alone. However, patients with stage I disease who have high-risk histologies are at a greater risk of recurrence and are eligible for adjuvant therapy.

High-risk histology:

Grade 3 tumors of any histology and any serous tumors, clear cell tumors, or carcinosarcomas are considered high-risk.

Treatment options for patients with stage I or stage II endometrial cancer who have high-risk histologies include:

Patients with serous or clear cell histologies have higher rates of recurrence than do patients with other stage I or stage II endometrioid carcinomas. Management guidelines are based on the outcomes reported in institutional case series that used a regimen of adjuvant carboplatin plus paclitaxel, and occasionally, radiation therapy for patients with this histological subtype.[1-9]

Carcinosarcomas have been evaluated in clinical trials both separately and with other sarcomas because of their prior designation in this group. In a nonrandomized Gynecologic Oncology Group (GOG) study of patients with stage I or II carcinosarcomas, patients who underwent pelvic radiation therapy had a significant reduction in recurrences within the radiation treatment field but no improvement in survival.[10] One nonrandomized study that predominantly included patients with carcinosarcomas appeared to show benefit for adjuvant therapy with cisplatin and doxorubicin.[11]