{"paper_id":"be3ae578-98b7-4216-9f90-ee643839cfe5","body_text":"Submit Manuscript | http://medcraveonline.com\nadditional omentectomy, appendectomy and biopsy of any suspected \nlesion.3–5,10,11,14 Positive pelvic washings should be reported separately, \nalthough they do not affect FIGO staging for EC.9\nLaparotomy is the preferable surgical technique for systematic \nsurgical staging in most EC patients. 3–5,10,11,15,16 However in EC \npatients with early stage disease, we can also use minimally invasive \ntechniques (laparoscopy, robotic-assisted surgery) for the same \npurpose.2–5,8,10–12,15–18\nIt is widely accepted that minimally invasive techniques have many \nsignificant advantages (smaller incisions, improved visualization, \nshorter hospital stay, less need for analgesics, quicker recovery \nand lower risk of postoperative complications). 3–5,8,10–12,15–19 Those \nadvantages are very important, especially in overweight and elderly \npatients.3–5,8,10–12,15–19\nThe various surgical techniques (laparotomy, minimally invasive \ntechniques) that applied in EC patients, have relatively small \ndifferences in recurrence rates.15,16 Moreover, those surgical techniques \n(laparotomy, minimally invasive techniques) associated with similar \noverall and disease-free survival rates.10,12,15,16\nIt should be mentioned that pelvic and para-aortic \nlymphadenectomy, are absolutely necessary in EC patients for the \ndiagnosis of stage IIIc disease. 3–5,8,9,11–13,20,21 Moreover the application \nof pelvic and para-aortic lymphadenectomy in patients with advanced \nstage type I EC and in all patients with type II EC, associated with \nimproved survival. 2–5,11,22–26 However the application of pelvic and \npara-aortic lymphadenectomy in patients with early stage type I EC, \ndo not improve survival.2–5,11,12,27,28\nMoreover the extent of pelvic and para-aortic lymphadenectomy \n(>14 lymph nodes), increases significantly the risk for postoperative \ncomplications.3–5,11,27,29,30 Especially in elderly patients and in patients \nwith relative comorbidities (obesity, diabetes, coronary artery disease), \npelvic and para-aortic lymphadenectomy increases significantly the \nintraoperative and postoperative morbidity.3–5,8,11,29,31,32 In any case, the \nintraoperative and postoperative morbidity must be carefully weighed \nagainst any survival advantage.3–5,11,29,31,32\nIt is obvious that the application of systematic surgical staging in \nEC patients, has diagnostic, prognostic and therapeutic benefits.2–5,8,11 \nMoreover, systematic surgical staging allows a more clear decision for \nthe selection of the appropriate postoperative adjuvant treatment.3–5,8,11 \nAdditionally, the application of the appropriate postoperative \nadjuvant treatment maximize survival and minimize the morbidity \nof overtreatment (radiation injury) and the effects of undertreatment \n(recurrent disease, increased mortality).3–5,8,11\nHowever according to ACOG, SGO and ESMO recommendations, \nthe application of postoperative adjuvant treatment (radiotherapy \nand/or chemotherapy) is absolutely necessary, particularly in EC \npatients with increased risk for recurrence or at advanced stage \ndisease.2–5,8,10,13,33,34 More specifically, the application of postoperative \nadjuvant radiotherapy in EC patients includes vaginal brachytherapy \nand external radiotherapy.3–5,10,11,34\nVaginal brachytherapy is the adjuvant treatment of choice \nparticularly in intermediate risk EC patients (stage IA grade 3 \nendometrioid type EC, stage IB grade 1-2 endometrioid type EC). 3–\n5,10,11,34–39 It is well tolerated, reduces the risk for local recurrences but \nhas no impact on overall survival. 34,35,38,40 Moreover, the application \nof vaginal brachytherapy associated with less side effects and \nbetter quality of life. 10,34–38,40 Additionally in intermediate risk EC \npatients, the application of vaginal brachytherapy is equivalent to the \napplication of external pelvic radiotherapy in achieving local control \nof disease.3–5,10,11,34–37\nExternal pelvic radiotherapy is the adjuvant treatment of choice \nparticularly in high risk EC patients (stage IB grade 3 endometrioid \ntype EC, stage I non-endometrioid type EC). 3–5,10,11,36,37,40 Although \nit reduces the risk for local recurrences, it has no impact on overall \nsurvival.3–5,8,34–36,38,41,42 However, the application of external pelvic \nradiotherapy associated with significant morbidity and reduction in \nquality of life.3–5,11,35,41\nWhole abdomen radiotherapy can be used in EC patients with \nadvanced stage disease.43 However, it can be used only in patients with \ncompletely resected disease. 43 Moreover, the application of whole \nabdomen radiotherapy has tolerable toxicity and may improve overall \nsurvival.3–5,11,43\nPostoperative adjuvant chemotherapy is the adjuvant treatment \nof choice particularly in EC patients with advanced stage \ndisease.2–5,10,11,13,34,44,45 The most active chemotherapeutic agents \nObstet Gynecol Int J. 2015;2(2):58‒60. 58\n©2015 Adonakis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and build upon your work non-commercially.\nPresent and future in endometrial cancer treatment \nVolume 2 Issue 2 - 2015\nDepartment of Obstetrics and Gynecology, \nUniversity of Patras, Greece\nDepartment of Obstetrics and Gynecology, University of Patras, \nGreece\nCorrespondence: Georgios Androutsopoulos, Assistant \nProfessor, Department of Obstetrics and Gynecology, \nUniversity of Patras, Medical School, Rion 26504, Greece, \nT el +306974088092, Email  \nReceived: March 14, 2015 | Published: April 8, 2015\nObstetrics & Gynecology International Journal \nEditorial\n Open Access\nEditorial\nIn the developed world, endometrial cancer (EC) is the most \nfrequent female genital tract malignancy. 1–5 The lifetime risk of \ndeveloping EC is 2.64%.1 It most commonly occurs in postmenopausal \nwomen.1–5 Moreover based on its clinical and pathological features, \nsporadic EC classified into 2 types (type I EC and type II EC).6,7 \nAccording to ACOG, FIGO, SGO and ESMO recommendations, \nsystematic surgical staging is the primary treatment for EC \npatients.3–5,8–12 Especially in patients with type I EC (endometrioid), \nsystematic surgical staging includes: total hysterectomy, bilateral \nsalpingo-oophorectomy, pelvic and para-aortic lymphadenectomy \nand complete resection of all disease. 2–5,8–13 However in patients \nwith type II EC (poorly differentiated, papillary serous, clear cell), \nsystematic surgical staging includes: total hysterectomy, bilateral \nsalpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and \n\nPresent and future in endometrial cancer treatment \n59\nCopyright:\n©2015 Adonakis et al.\nCitation: Adonakis G, Decavalas G, Androutsopoulos G. Present and future in endometrial cancer treatment. Obstet Gynecol Int J. 2015;2(2):58‒60. \nDOI: 10.15406/ogij.2015.02.00031\nfor those EC patients, are: taxanes, anthracyclines and platinum \ncompounds.44,46 Although the application of adjuvant chemotherapy \nachieves high response rates, it has only modest effect in progression \nfree survival and overall survival. 3–5,11,44 Moreover, the application \nof adjuvant chemotherapy is more effective than the application of \nwhole abdomen radiotherapy.3–5,11,33,47\nCombined application of adjuvant chemotherapy and radiotherapy \nis a promising adjuvant treatment particularly in high risk EC \npatients and in EC patients at advanced stage disease. 3–5,11,34,44,48 \nEspecially in EC patients with completely resected disease, the \ncombined application of adjuvant chemotherapy and radiotherapy \nsignificantly reduce the risk of relapse or death and increase overall \nsurvival.3–5,10,11,34,49 Moreover, the combined application of adjuvant \nchemotherapy and radiotherapy is more effective than the application \nof adjuvant radiotherapy alone.3–5,11,34,44,49\nRecent years, molecular targeted therapies have increasing \npopularity.3–5,11 However, they have only modest effect in unselected \nEC patients.3–5,11,44,50–53 Moreover the application of molecular targeted \ntherapies, usually target the signaling pathways of EGFR, VEGFR \nand PI3K/PTEN/AKT/Mtor. 54–56 More specifically, ErbB-targeted \ntherapies can be used as adjuvant treatment especially in type II \nEC patients with EGFR and ErbB-2 overexpression. 3–5,11,50–53,56–63 \nHowever, additional studies into the molecular pathways of EC are \nnecessary.3–5,11,50–52,62,63\nIt is obvious that the present and future in endometrial cancer \ntreatment is extremely challenging, especially regarding the \napplication of postoperative adjuvant treatment in EC patients with \nincreased risk for recurrence or at advanced stage disease.\nAcknowledgments \nNone. \nConflicts of interest \nThe authors declare there is no conflict of interests.\nReferences\n1. 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