Updated Guidelines

ASTRO Updates Guidelines on Radiation Therapy for Endometrial Cancer

The American Society for Radiation Oncology (ASTRO) recently updated its 2014 guidance on the post-surgical use of radiation therapy and systemic therapy to treat patients with endometrial cancer. The guideline, which was based on a systematic literature review of articles published through August 2021, includes treatment algorithms for stage I-II endometrial cancers, stage I-II cancers with high-risk histologies, and stage III-IVA cancers.

Endometrial cancer is the most common type of gynecological cancer in the United States, with treatment involving not only the surgical removal of the patient’s uterus, cervix, fallopian tubes, and ovaries, but also post-operative therapy for those with risk factors for cancer recurrence.

According to Beth A. Erickson, MD, FASTRO, chair of the guideline task force and a professor of radiation oncology at the Medical College of Wisconsin in Milwaukee, the taskforce examined high-quality clinical trials on the usefulness of post-operative therapy for patients with different disease stages and risk profiles. The taskforce, which consisted of subject matter experts, then synthesized the findings from those trials into recommendations for external beam radiation therapy (EBRT), vaginal brachytherapy (VBT), and chemotherapy in the post-surgical setting, with a focus on multidisciplinary, patient-centered care.

The newly updated guideline also touched on the role of surgical staging and molecular profiling approaches in determining whether a patient should receive post-operative therapy.

The updated guideline includes several recommendations. For example:

  • Radiation therapy is recommended to reduce the risk of locoregional recurrence, based on a patient’s clinical-pathologic risk factors.
  • When choosing between EBRT vs VBT in FIGO stage I endometrial cancer, physicians should make a lymph node assessment and consider uterine risk factors.
  • For patients with stage I disease and high-risk features, or stage II-IV disease, EBRT is recommended.

Additional recommendations involved the sequencing of radiation therapy with chemotherapy for those with high-risk histologies and/or stage III-IV disease, intensity-modulated radiation therapy, sentinel lymph node mapping over pelvic lymphadenectomy, and molecular tumor profiling.

The clinical guideline was developed in collaboration with the American Brachytherapy Society, the American Society of Clinical Oncology and the Society of Gynecologic Oncology. It is endorsed by the Canadian Society of Radiation Oncology, European Society for Radiotherapy and Oncology, and the Royal Australian and New Zealand College of Radiologists.


—Anthony Calabro



Harkenrider MM, Abu-Rustum N, Albuquerque K, et al. Radiation therapy for endometrial cancer: An ASTRO clinical practice guideline. Pract Radiat Oncol. Published online October 21, 2022. doi:10.1016/j.prro.2022.09.002