This paper covers an overview of the literature on the management of advanced endometrial cancer, concentrating on patients with histopathologic endometrioid type of tumors. The different treatment modalities are described and management recommendations are proposed. The standard surgical procedure includes an extrafacial total hysterectomy with bilateral salpingo-oophorectomy, collection of peritoneal washings for cytology, and exploration of the intraabdominal contents. In cases of extensive disease in the abdomen, an optimal surgical cytoreduction is associated with improved survival. Further treatment with radiotherapy may be indicated based on the pathological staging information to improve loco-regional control. Primary radiotherapy is indicated in cases where surgery is contraindicated. Systemic treatment can either be hormone therapy or chemotherapy. Progesterons are the cornerstone of hormone therapy. Prognostic factors for response are the presence of high levels of progesterone and estrogen receptors and low grade histology. Paclitaxel is the most active single agent drug. The combination therapy with paclitaxel and carboplatin is adopted as first choice in patients with endometrial cancer because of the efficacy and low toxicity, although not proven in a randomized trial. The literature on the management of patients with advanced endometrial cancer is discussed in detail. Each stage of advanced disease is presented separately, and management recommendations are proposed, and alternative approaches are given. Ongoing clinical trials are described, and the focuses of ongoing research are mentioned.

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Keywords Advanced, Endometrial cancer, Management, adnexa disease, advanced cancer, alopecia, altretamine, amifostine, antineoplastic metal complex, bone marrow suppression, brachytherapy, cancer chemotherapy, cancer patient, cancer radiotherapy, cancer staging, cancer surgery, cancer survival, carboplatin, cisplatin, clinical trial, cyclophosphamide, cytology, cytoreductive surgery, doxorubicin, drug efficacy, dyspnea, endometrium cancer, endometrium carcinoma, epirubicin, estrogen receptor, fluid retention, fluorouracil, gastrointestinal toxicity, gestagen, gonadorelin agonist, histology, hormonal therapy, human, hydroxyprogesterone caproate, hysterectomy, ifosfamide, information, medroxyprogesterone acetate, megestrol acetate, melphalan, metastasis, nephrotoxicity, neurotoxicity, paclitaxel, pathogenesis, peritoneum, priority journal, progesterone, progesterone receptor, prognosis, radiation dose, recombinant granulocyte colony stimulating factor, recurrent cancer, review, salpingooophorectomy, serosa, side effect, treatment contraindication, treatment indication, treatment response, weight gain
Persistent URL dx.doi.org/10.1111/IGC.0b013e3181a1a04f, hdl.handle.net/1765/17150
Citation
van Wijk, F.H., van der Burg, M., Burger, C.W., Vergote, I., & van Doorn, H.C.. (2009). Management of surgical stage III and IV endometrioid endometrial carcinoma: An overview. International Journal of Gynecological Cancer, 19(3), 431–446. doi:10.1111/IGC.0b013e3181a1a04f