Local therapy in endometrial cancer: evidence based review

(1) Surgery is the standard primary treatment for early stage endometrial cancer, with local adjuvant therapies such as pelvic radiotherapy and vaginal brachytherapy most often used in patients with high risk of recurrence. (2) There are currently very few well designed studies evaluating local therapies in endometrial cancer. (3) To date, the available evidence suggests that adjuvant external beam radiotherapy reduces locoregional recurrence in stage I disease but not the risk of death. Considering the high survival rate and low recurrence risk of patients with early stage disease, postoperative adjuvant radiotherapy should perhaps be limited to patients with high risk of recurrence, particularly since such radiotherapy is associated with increased long-term complications and toxicity. (4) Adjunctive chemotherapy has so far failed to demonstrate any improvement over radiotherapy in terms of overall survival in patients with intermediate and high-risk endometrial cancer. (5) Further well controlled studies are required in order to confidently establish the optimal use of local treatments and other therapies in endometrial cancer.