A Modern Approach to Endometrial Carcinoma: Will Molecular Classification Improve Precision Medicine in the Future?
Abstract
:Simple Summary
Abstract
1. Introduction
1.1. Current Risk Stratification
1.2. Limitations of Clinical Risk Factors
1.3. Current Recommendations for Adjuvant Treatment in Low-Risk Disease and Intermediate-Risk Parameters
1.3.1. Radiation Needed in Stage I?
1.3.2. Radiation, Chemotherapy or Both: Who Could Profit?
1.3.3. The Need for Additional Differentiation of EC to Predict Adjuvant Therapy
1.4. Response Predicition for Chemotherapy and Radiation
1.5. New Study Landscape
1.6. New Guidelines for Adjuvant Treatment
2. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Risk Group | Molecular Classification Un-Known | Molecular Classification Known |
---|---|---|
Low |
|
|
Intermediate |
|
|
High-Intermediate |
|
|
High |
|
|
Advanced Metastatic |
|
|
New Risk Groups According to Figure 1 | Future Adjuvant Treatment Recommendations (Suggestions) | ||
---|---|---|---|
Brachytherapy | External Beam Radiation | Chemotherapy | |
Low Risk | no | no | no |
Intermediate Risk | yes | no | no |
High-Intermediate Risk pN0 (surgical staging or SLN neg.) | yes | If substantial LVSI | no |
High-Intermediate Risk cN0/pNX (no surgical staging nor SLN) | yes | If substantial LVSI | Especially for NSMP grade 3 (see PORTEC3 protocol) |
High Risk p53+ regardless of stage; stage IIIC1 NSMP/MMRd, no residual tumor | no | Concurrent chemoradiation +chemo (see PORTEC3 protocol) In case of contra-indications against chemo: EBRT recommended | |
High Risk stage III C2 | no | Extended field radiation: Concurrent chemoradiation + chemo (see PORTEC3 protocol) In case of contra-indications against chemo: EBRT recommended |
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Marnitz, S.; Walter, T.; Schömig-Markiefka, B.; Engler, T.; Kommoss, S.; Brucker, S.Y. A Modern Approach to Endometrial Carcinoma: Will Molecular Classification Improve Precision Medicine in the Future? Cancers 2020, 12, 2577. https://doi.org/10.3390/cancers12092577
Marnitz S, Walter T, Schömig-Markiefka B, Engler T, Kommoss S, Brucker SY. A Modern Approach to Endometrial Carcinoma: Will Molecular Classification Improve Precision Medicine in the Future? Cancers. 2020; 12(9):2577. https://doi.org/10.3390/cancers12092577
Chicago/Turabian StyleMarnitz, Simone, Till Walter, Birgid Schömig-Markiefka, Tobias Engler, Stefan Kommoss, and Sara Yvonne Brucker. 2020. "A Modern Approach to Endometrial Carcinoma: Will Molecular Classification Improve Precision Medicine in the Future?" Cancers 12, no. 9: 2577. https://doi.org/10.3390/cancers12092577