Endometrial carcinoma: the current role of adjuvant radiation

Endometrial cancer is the most common gynaecological malignancy in the USA, expected to account for over 40,000 new cases and 7,400 deaths in 2008. Risk factors for local-regional recurrence after surgery have been identified in surgical-pathological studies as well as prospective randomised trials. While most women with early stage, low risk disease do well without adjuvant therapy, those in higher risk groups frequently recur both locally and distantly. The use of adjuvant radiation therapy has been controversial since randomised trials have demonstrated improvement in local control, without a clear impact on survival. The magnitude of potential benefit is dependent on combinations of risk factors. In this review, we use the available data to help guide the selection of patients for whom radiotherapy may be beneficial, and provide recommendations regarding treatment volumes and methods of delivery.