American Society for Radiation Oncology

View all recommendations from this society

Released September 15, 2014

Don’t recommend radiation following hysterectomy for endometrial cancer patients with low-risk disease.

Patients with low-risk endometrial cancer including no residual disease in hysterectomy despite positive biopsy, grade 1 or 2 with <50% myometrial invasion and no additional high risk features such as age >60, lymphovascular space invasion or cervical involvement have a very low risk of recurrence following surgery.

Meta-analysis studies of radiation therapy for low-risk endometrial cancer demonstrate increased side effects with no benefit in overall survival compared with surgery alone.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

1–5: Following approval of the participation of the American Society for Radiation Oncology (ASTRO) in the Choosing Wisely campaign, a survey was sent to ASTRO committees and panels related to health policy, government relations, and clinical affairs and quality in order to identify potential items for inclusion in the list. A work group, comprised of seven physicians drawn from these three areas, was also selected and convened. The work group members were asked to pick their top eight items from the total of 34 topics that had been suggested in the initial survey. The results were tabulated and a list of the highest scoring items generated, creating a short list of 13 draft items.

Three conference calls were subsequently held to further refine the list and finalize the wording of the items based on input from ASTRO’s Board of Directors. A literature review was conducted for each topic by ASTRO staff and each work group member took the lead on writing text and selecting references for one or more draft items. The final items for submission were selected by ASTRO’s Board of Directors. ASTRO’s disclosure and conflict of interest policy can be found at: www.astro.org.

6–10: In January 2014, the American Society for Radiation Oncology (ASTRO) formed a group to develop its second Choosing Wisely list, which included representatives from health policy, government relations, and clinical affairs and quality. The work group began by narrowing a list of 28 draft concepts to nine potential Choosing Wisely items. Next, an electronic anonymous survey was sent to the ASTRO membership to rate the value and relevancy of each of the items. The survey also included an open text box for members to comment on the suggested items and to provide additional ideas for Choosing Wisely items. Based on the survey results, the work group submitted a short list of eight items to the ASTRO Board of Directors, from which the Board chose five items to move forward.

Literature reviews were conducted for the five Choosing Wisely items selected by the Board and the group drafted verbiage, bullet points and references for each item. Following a second review by the Board of Directors, one of the items was replaced with an alternate item from the short list. The final list received approval from the Board and was then submitted to the ABIM Foundation. ASTRO’s disclosure and conflict of interest policy can be found at: www.astro.org.

Sources

Diavolitsis V, Rademaker A, Lurain J, Hoekstra A, Strauss J, Small W Jr. Clinical outcomes in international federation of gynecology and obstetrics stage IA endometrial cancer with myometrial invasion treated with or without postoperative vaginal brachytherapy. Int J Radiat Oncol Biol Phys. 2012Oct 1;84(2):415–9.

Johnson N, Cornes P. Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta-analysis. BJOG. 2007 Nov;114(11):1313–20.

Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012 Nov 7;104(21):1625–34.

Creutzberg CL, Nout RA. The role of radiotherapy in endometrial cancer: current evidence and trends. Curr Oncol Rep. 2011 Dec;13(6):472–8.

Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, et al. The role of postoperative radiation therapy for endometrial cancer: executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014 May-Jun;4(3):137–44.