Current therapy of patients with endometrial carcinoma. A critical review

Magnetic resonance imaging (MRI), 18-FDG positron emission tomography ((18)FDG PET-CT), and computed tomography (CT) have demonstrated disappointing detectability of lymph node metastases in endometrial cancer. The treatment of choice in patients with endometrial cancer is hysterectomy and bilateral salpingoophorectomy. Above all, obese patients with comorbidity have benefited the most from laparoscopically assisted approaches. For inoperable patients in FIGO stage I/II, radiation remains an alternative to hysterectomy. The role of pelvic and paraaortic lymphadenectomy is the most controversial issue in endometrial carcinoma treatment. The current spectrum of treatment ranges from no lymphadenectomy, exclusive pelvic or additional inframesentric paraaortic sampling, or complete pelvic to infrarenal paraaortic lymphadenectomy. The sentinel concept in patients with endometrial carcinoma is far from being introduced into routine clinical practice. Without a lymphadenectomy, decision making for adjuvant therapy remains a challenge, because no information is available from lymph node status and the reliability of pathologic grading is poor. For patients after hysterectomy with a low risk of local relapse (stage I/II without additional risk factors), vaginal brachytherapy is sufficient to prevent vaginal relapses. Adjuvant external beam irradiation (EBRT) in stage I/II demonstrated improved local control which impacted overall survival only in patients with high-risk features (higher age, grading myometrial infiltration). Stage IIIC patients seem to benefit from EBRT with regard to overall survival. In patients at high risk of progression (grade 3, MI > 50%, FIGO IIIC, unfavorable histology), multimodal treatment should be considered. The optimal substances and sequences are under investigation.