NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021

Abu‐Rustum, Nadeem R.; Yashar, Catheryn M.; Bradley, Kristin; Campos, Susana M.; Chino, Junzo; Chon, Hye Sook; Chu, Christina; Cohn, David E.; Crispens, Marta A.; Damast, Shari; Diver, Elisabeth; Fisher, Christine M.; Frederick, Peter J.; Gaffney, David K.; George, Suzanne; Giuntoli, Robert L.; Han, Ernest; Howitt, Brooke E.; Huh, Warner K.; Lea, Jayanthi; Mariani, Andrea; Mutch, David G.; Nekhlyudov, Larissa; Podoll, Mirna; Remmenga, Steven W.; Reynolds, R. Kevin; Salani, Ritu; Sisodia, Rachel; Soliman, Pamela T.; Tanner, Edward J.; Ueda, Stefanie; Urban, Renata R.; Wethington, Stephanie L.; Wyse, Emily; Zanotti, Kristine; McMillian, Nicole R.; Motter, Angela D.

doi:10.6004/jnccn.2021.0038

Cited by 135 publications

(118 citation statements)

References 33 publications

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“…In a study of families with Lynch syndrome, the cumulative risk of EC by age 70 years was significantly higher among carriers of MLH1 mutations (54%), but this risk did not exceed 2% in women younger than 40 years of age [28]. As described in the National Comprehensive Cancer Network (NCCN-USA) guidelines for hereditary cancers, all women with EC should be genetically tested for MMR mutations, especially if diagnosed under 50 years of age, and if they are members of Lynch families [4].…”

Section: Fertility Sparing Treatments 21 Patients Selectionmentioning

confidence: 99%

“…Medical treatment and uterine sparing management are now accepted as reasonable short-term alternatives to definitive surgical management in highly selected patients [4]. The fertility sparing treatment (FST) in EC includes hysteroscopic resection and/or curettage, in combination with hormonal therapy with progestin.…”

Section: Introductionmentioning

confidence: 99%

“…of EC patients seems to be feasible and safe in selected patients, affected by Grade1 endometrioid EC or by premalignant disease such EIN[4]. Thanks to the recent classification models byColombo et al.…”

mentioning

confidence: 99%

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Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Cavaliere

Perelli

Zaami

et al. 2021

IJMS

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Endometrial cancer is the most frequent gynecological malignancy, and, although epidemiologically it mainly affects advanced age women, it can also affect young patients who want children and who have not yet completed their procreative project. Fertility sparing treatments are the subject of many studies and research in continuous evolution, and represent a light of hope for young cancer patients who find themselves having to face an oncological path before fulfilling their desire for motherhood. The advances in molecular biology and the more precise clinical and prognostic classification of endometrial cancer based on the 2013 The Cancer Genome Atlas classification allow for the selection of patients who can be submitted to fertility sparing treatments with increasing oncological safety. It would also be possible to predict the response to hormonal treatment by investigating the state of the genes of the mismatch repair.

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Section: Fertility Sparing Treatments 21 Patients Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Cavaliere

Perelli

Zaami

et al. 2021

IJMS

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“…In 1997, Kim et al first reported that 13 of 21 (62%) patients who were treated with progestin alone for type I EC had an initial response to progestins ( 5 ), beginning the exploration of the criteria for the conservative treatment. At present, relevant guidelines for fertility preservation treatment of EC have been launched, including the NCCN 1 ( 6 ), the Gynecological Oncology Committee of Chinese Anti-Cancer Association ( 7 ), and the European Society of Gynecological Oncology (ESGO) ( 8 – 11 ). The main indications agreed by the above guidelines/expert consensus are as follows: 1) Well-differentiated (grade 1) endometrioid adenocarcinoma confirmed by expert pathology review, 2) Disease limited to the endometrium on imaging, 3) Absence of suspicious or metastatic disease on imaging, 4) No contraindications to medical therapy or pregnancy, and 5) Patients should undergo counseling as the fertility-sparing option is not standard of care for the treatment of endometrial carcinoma.…”

Section: The Conservative Treatment Of Ecmentioning

confidence: 99%

The Advance and Correlation of KRAS Mutation With the Fertility-Preservation Treatment of Endometrial Cancer in the Background of Molecular Classification Application

Yu¹,

Wang²

2021

Pathol. Oncol. Res.

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The annually increasing incidence of endometrial cancer in younger women has created a growing demand for fertility preservation. However, the diverse therapeutic efficacy among patients under the same histological subtype and the same tumor grade suggests the potential interference of the innate molecular characteristics. The molecular classification has now been applied in clinical practice and might help to stratify the endometrial cancer patients and individualize the therapy, but the candidates for the fertility-spared treatment are most likely to be subdivided in the subgroup lacking the specific signature. KRAS mutation has been linked to the malignant transition of the endometrium, while its role in molecular classification and fertility preservation is vague. Here, we mainly review the advance of molecular classification and the role of KRAS in endometrial cancer, as well as their correlation with fertility-preservation treatment.

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“…HDR-VBT as the sole adjuvant post-operative radiation technique is currently considered the standard care for many subgroups of patients with early-stage disease [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Biological Planning of Radiation Dose Based on In Vivo Dosimetry for Postoperative Vaginal-Cuff HDR Interventional Radiotherapy (Brachytherapy)

et al. 2021

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(1) Background: Postoperative vaginal-cuff HDR interventional radiotherapy (brachytherapy) is a standard treatment in early-stage endometrial cancer. This study reports the effect of in vivo dosimetry-based biological planning for two different fractionation schedules on the treatment-related toxicities. (2) Methods: 121 patients were treated. Group A (82) received 21 Gy in three fractions. Group B (39) received 20 Gy in four fractions. The dose was prescribed at a 5 mm depth or to the applicator surface according to the distance between the applicator and the rectum. In vivo dosimetry measured the dose of the rectum and/or urinary bladder. With a high measured dose, the dose prescription was changed from a 5 mm depth to the applicator surface. (3) Results: The median age was 66 years with 58.8 months mean follow-up. The dose prescription was changed in 20.7% of group A and in 41% of group B. Most toxicities were grade 1–2. Acute urinary toxicities were significantly higher in group A. The rates of acute and late urinary toxicities were significantly higher with a mean bladder dose/fraction of >2.5 Gy and a total bladder dose of >7.5 Gy. One patient had a vaginal recurrence. (4) Conclusions: Both schedules have excellent local control and acceptable rates of toxicities. Using in vivo dosimetry-based biological planning yielded an acceptable dose to the bladder and rectum.

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NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021

Cited by 135 publications

References 33 publications

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

The Advance and Correlation of KRAS Mutation With the Fertility-Preservation Treatment of Endometrial Cancer in the Background of Molecular Classification Application

Biological Planning of Radiation Dose Based on In Vivo Dosimetry for Postoperative Vaginal-Cuff HDR Interventional Radiotherapy (Brachytherapy)

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