4 januari 2023: zie ook literatuurlijst voeding en niet-toxische middelen en behandelingen specifiek bij baarmoederkanker en baarmoederhalskanker samengesteld door arts-bioloog drs. Engelbert Valstar 

4 januari 2023: Bron: the American Society for Radiation Oncology

In richtlijnen hoe in de klinische praktijk om te gaan met radiotherapie - bestraling bij patiënten met baarmoederkanker (endometriumkanker)  worden door  the  American Society for Radiation Oncology aanbevelingen gedaan voor het gebruik van aanvullende radiotherapie - bestraling na chirurgische ingreep bij diagnose van baarmoederkanker (endometriumkanker). 
De samenstellers van deze richtlijnen bevelen radiotherapie - bestraling aan in de vorm van vaginale brachytherapie of uitwendige bestralingstherapie via IMRT - Intensiteitsgemoduleerde radiotherapie om het risico op vaginale en/of bekkenrecidief te verkleinen, op basis van de klinisch-pathologische risicofactoren van de patiënt. Intensiteitsgemoduleerde bestralingstherapie met dagelijkse beeldgeleide bestralingstherapie wordt aanbevolen wanneer uitwendige bestralingstherapie wordt toegediend om acute en late toxiciteit te verminderen.

Conclusies uit de nieuwe richtlijnen vertaald via google translate:

•De keuze van EBRT - uitwendige bestraling versus vaginale Brachytherapie - VBT bij FIGO stadium baarmoederkanker moet afhangen van de prestatie en methode van lymfeklierbeoordeling en de uteriene risicofactoren, waaronder de mate van LVSI en histologie en leeftijd van de patiënt.
•EBRT - uitwendige bestraling verlaagt het risico op locoregionaal recidief, vooral bij patiënten met de ziekte van FIGO stadium I met risicovolle kenmerken of risicovolle histologieën, de ziekte van FIGO stadium II en de ziekte van FIGO stadium III tot IVA.
•Wanneer EBRT - uitwendige bestraling geïndiceerd is, wordt het gebruik van IMRT - Intensiteitsgemoduleerde radiotherapie geassocieerd met verbeterde door de patiënt gerapporteerde uitkomsten en acute en late toxiciteit. Het creëren van een vaginale ITV met dagelijkse beeldgeleiding zorgt voor een nauwkeurige dagelijkse behandeling.
•Systemische chemotherapie moet effectief worden gevolgd met radiotherapie bij patiënten met hoog-risico histologieën van alle stadia en in FIGO stadium III tot IVA ziekte van alle histologieën om recidief op afstand respectievelijk locoregionaal te verminderen.
•SLN-mapping met pathologische ultrastaging verbetert de nauwkeurigheid van chirurgische stadiëring en resulteert in minder morbiditeit dan lymfadenectomie in het bekken. Aanvullende therapie moet worden aanbevolen op basis van de klinische en uteriene risicofactoren, de uitvoering van een lymfklier beoordeling en de resultaten van die lymfklier beoordeling.
•Voor patiënten met baarmoederkanker die aanvullende therapie overwegen, wordt moleculaire profilering aanbevolen en kan deze worden gebruikt als leidraad voor aanvullende therapie.

"Voor patiënten met een verhoogd risico op recidief na een operatie van baarmoederkanker, tonen klinische onderzoeken consequent aan dat aanvullende therapie de resultaten kan verbeteren", zegt een co-auteur van de richtlijnen in een verklaring.

De richtlijnen zijn samengesteld op basis van wetenschappelijke studies die bij elke situatie vermeld wordt in de richtlijnen en zijn gepubliceerd via deze studie. Klik op de titel en scroll daar door voor de richtlijnen.:


Radiation Therapy for Endometrial Cancer: An American Society for Radiation Oncology Clinical Practice Guideline

Published:October 21, 2022DOI:https://doi.org/10.1016/j.prro.2022.09.002



With the results of several recently published clinical trials, this guideline informs on the use of adjuvant radiation therapy (RT) and systemic therapy in the treatment of endometrial cancer. Updated evidence-based recommendations provide indications for adjuvant RT and the associated techniques, the utilization and sequencing of adjuvant systemic therapies, and the effect of surgical staging techniques and molecular tumor profiling.


The American Society for Radiation Oncology convened a multidisciplinary task force to address 6 key questions that focused on the adjuvant management of patients with endometrial cancer. The key questions emphasized the (1) indications for adjuvant RT, (2) RT techniques, target volumes, dose fractionation, and treatment planning aims, (3) indications for systemic therapy, (4) sequencing of systemic therapy with RT, (5) effect of lymph node assessment on utilization of adjuvant therapy, and (6) effect of molecular tumor profiling on utilization of adjuvant therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation.


The task force recommends RT (either vaginal brachytherapy or external beam RT) be given based on the patient's clinical-pathologic risk factors to reduce risk of vaginal and/or pelvic recurrence. When external beam RT is delivered, intensity modulated RT with daily image guided RT is recommended to reduce acute and late toxicity. Chemotherapy is recommended for patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II with high-risk histologies and those with FIGO stage III to IVA with any histology. When sequencing chemotherapy and RT, there is no prospective data to support an optimal sequence. Sentinel lymph node mapping is recommended over pelvic lymphadenectomy for surgical nodal staging. Data on sentinel lymph node pathologic ultrastaging status supports that patients with isolated tumor cells be treated as node negative and adjuvant therapy based on uterine risk factors and patients with micrometastases be treated as node positive. The available data on molecular characterization of endometrial cancer are compelling and should be increasingly considered when making recommendations for adjuvant therapy.


These recommendations guide evidence-based best clinical practices on the use of adjuvant therapy for endometrial cancer.


As the leading organization in radiation oncology, the American Society for Radiation Oncology (ASTRO) is dedicated to improving quality of care and patient outcomes. A cornerstone of this goal is the development and dissemination of clinical practice guidelines based on systematic methods to evaluate and classify evidence, combined with a focus on patient-centric care and shared decision making. ASTRO develops and publishes guidelines without commercial support, and members volunteer their time.
Disclosure Policy—ASTRO has detailed policies and procedures related to disclosure and management of industry relationships to avoid actual, potential, or perceived conflicts of interest. All task force members are required to disclose industry relationships and personal interests from 12 months before initiation of the writing effort. Disclosures go through a review process with final approval by ASTRO's conflict of interest review committee. For the purposes of full transparency, task force members’ comprehensive disclosure information is included in this publication. Peer reviewer disclosures are also reviewed and included (Supplemental Materials, Appendix E1). The complete disclosure policy for formal papers is online.
Selection of Task Force Members—ASTRO strives to avoid bias and is committed to creating a task force that includes a diverse and inclusive multidisciplinary group of experts considering race, ethnicity, gender, experience, practice setting, and geographic location. Representatives from organizations and professional societies with related interests and expertise are also invited to serve on the task force, as well as a patient representative.
Methodology—ASTRO's task force uses evidence-based methodologies to develop guideline recommendations in accordance with the National Academy of Medicine standards. ,  The evidence identified from key questions (KQs) is assessed using the Population, Intervention, Comparator, Outcome, Timing, Setting (PICOTS) framework. A systematic review of the KQs is completed, which includes creation of evidence tables that summarize the evidence base task force members use to formulate recommendations. Table 1 describes ASTRO's recommendation grading system. See Appendix E2 in Supplemental Materials for a list of abbreviations used in the guideline.

Conclusions and Future Directions

Just as significant evolution of adjuvant therapy in endometrial cancer has occurred since the publication of the 2014 ASTRO endometrial guideline, much more is anticipated in the coming years. The following are conclusions of this guideline:
  • The choice of EBRT versus VBT in FIGO stage I endometrial cancer should depend on the performance and method of lymph node assessment and the uterine risk factors, including the degree of LVSI and histology and patient age.
  • EBRT decreases the risk of locoregional recurrence, especially in patients with FIGO stage I disease with high-risk features or high-risk histologies, FIGO stage II disease, and FIGO stage III to IVA disease.
  • When EBRT is indicated, the use of IMRT is associated with improved patient-reported outcomes and acute and late toxicity. Creation of a vaginal ITV with daily image guidance ensures accurate daily treatment delivery.
  • Systemic chemotherapy should be effectively sequenced with RT in patients with high-risk histologies of all stages and in FIGO stage III to IVA disease of all histologies to decrease distant and locoregional recurrence, respectively.
  • SLN mapping with pathologic ultrastaging improves the accuracy of surgical staging and results in less morbidity than pelvic lymphadenectomy. Adjuvant therapy should be recommended based on the clinical and uterine risk factors, performance of a nodal assessment, and results of that nodal assessment.
  • For patients with endometrial cancer considering adjuvant therapy, molecular profiling is recommended and may be used to guide adjuvant therapy.
Future directions in adjuvant management are likely to be driven by further discoveries and thoughtfully designed clinical trials. Equity-focused clinical research, including diverse study teams, inclusive enrollment practices, pragmatic study designs, and targeted dissemination of results, will ensure more equitable cancer treatment for all patients with endometrial cancer. Better understanding of the patterns of failure and long-term outcomes for patients undergoing SLN mapping with pathologic ultrastaging is likely to inform which patients with high-risk uterine risk factors can safely omit EBRT and/or chemotherapy. SLN mapping is a more accurate and less morbid staging procedure, but data will emerge if SLN-staged patients have a lower risk of pelvic recurrences to support de-escalation of adjuvant therapy. Similarly, molecular characterization is moving into the forefront and informing on both prognosis and predictive use of adjuvant therapy for patients with endometrial cancer. Studies prospectively incorporating molecular profiling into their randomization and stratification will be important to evolve the standard of care to molecular profile-guided decision making for adjuvant (and possibly even surgical) management. As more prognostic molecular markers are discovered, a more complete and personalized treatment plan can be delivered. Future work will methodically evolve from histology, grade, and stage to molecular-based prognostic and predictive utilization of adjuvant therapy.

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