Controversies in adjuvant systemic and radiation therapy of endometrial cancer

Adjuvant treatment of patients with endometrial cancer depends on clinical and pathological risk factors. For low risk endometrial cancer the standard treatment is surgery alone without any adjuvant therapy. For intermediate risk endometrial cancer the use of postoperative radiation therapy should be limited to the group of patients with a sufficiently high risk of locoregional recurrence (15% or more) to warrant the risk of treatment-associated morbidity and in order to maximize initial local control and relapse-free survival. Recent data suggest that vaginal brachytherapy alone should preferably be used to reduce the risk of vaginal relapse with less morbidity and better quality of life. For high risk disease the combination of platin-based chemotherapy and radiation therapy is the most effective adjuvant treatment. Unanswered questions currently remaining are the selection of drugs for combination with platin, how many cycles and the sequence of chemotherapy in relation to radiation therapy. For the answers to these questions the results of ongoing randomized trials must be awaited.