15. Inclusion Criteria:
High risk endometrial CA FIGO I
Endometroid type Grade 3 ;with deep endometrial invasion or LVSI
Endometroid type stage II or III
Clear or Serous types Stage I-III
Parametrial invovlement
24. Merits:
Multicentric trial with strong international collaboration (six groups) : highly
representative of current world wide practice
The primary endpoints were overall survival and failure free survival.
The funding bodies had no role in the study design ;data collection,
interpratation, analysis, or writing of report
Central pathology review was dine by reference gynaecopathologists
Toxicity assessed by independent comittee using CTCAE
25. Limitations:
Surgical staging varies
Radiation dosage and types of radiation modalities not uniform
Final outcomes / analysis were time based rather than events base; long
term outcomes needs to be analysed.
Costs of CTRT in terms of toxicity and treatment duration needs to be
weighed against benefits
26. Conclusion:
CTRT no overall survival benefit (5% );
5 year failure free survival 11% improvement
Toxicities more in CTRT group: rapid recovery
Response better in endometroid type: serous and clear cell types
associated with poorer prognosis
27. Summary
Risk groups for adjuvant Treatment:
Low Risk : Endometroid IA, G-1/G2
NAT
Low Intermediate Risk: Endometroid IB ; IC G1/G2
LND-> NAT, No LND->VBT
High intermediate risk: stage IIA, IC or G3; LVI; >60 yrs,
LND-> VBT , No LND->EBRT
High Risk Group: endometroi IC & G3; II B;serous or clear cell
EBRT , ? CTRT
