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Obstet Gynecol Sci > Epub ahead of print
DOI: https://doi.org/10.5468/ogs.21219    [Epub ahead of print]
Published online March 28, 2022.
Management of inoperable endometrial cancer
Supakorn Pitakkarnkul1, Saranya Chanpanitkitchot2, Siriwan Tangjitgamol3,4 
1Division of Gynecologic Oncology, National Cancer Institute, Bangkok, Thailand
2Department of Obstetrics and Gynecology, Rajavithi Hospital, Rangsit University College of Medicine, Bangkok, Thailand
3Women’s Care Center, MedPark Hospital, Bangkok, Thailand
4Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Correspondence:  Siriwan Tangjitgamol,
Email: siriwanonco@yahoo.com
Received: 5 July 2021   • Revised: 18 December 2021   • Accepted: 7 March 2022
Abstract
Some endometrial cancer (EMC) patients are not good candidates for primary surgery. The three major types of treatment for inoperable EMC are radiation therapy, chemotherapy, or their combination as neoadjuvant treatment before surgery. Radiation therapy alone (of different modes) has been used as the sole definitive therapeutic modality, particularly for early-stage disease that is limited to the uterine body and cervix with or without parametrial invasion. The most common treatment modality is neoadjuvant treatment before surgery. Postoperative adjuvant treatment is also occasionally used, depending mainly on the sites of the disease and the results of surgery. Data on neoadjuvant hormonal or radiation therapy are limited, with studies focusing on laboratory outcomes or having only a small number of patients. Most neoadjuvant treatments before surgery involved chemotherapy and fewer combined chemoradiotherapy. Surgery was generally performed, particularly in patients who had shown responses or at least stable disease to neoadjuvant treatment. Perioperative outcomes after neoadjuvant treatment were superior to those after primary surgery, whereas survival data were still inconsistent. Features that had or tended to have a favorable prognosis were younger age, early-stage disease, response to neoadjuvant treatment, low preoperative cancer antigen-125 level, and optimal surgery. Among different modalities of neoadjuvant treatment, which has become a frequent mode of treatment, neoadjuvant chemotherapy was more common than radiation therapy alone or chemoradiation.
Key Words: Endometrial cancer, Radiotherapy, Chemotherapy, Quality of life


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