1 / 51

Endometrial Carcinoma ESMO-ESTRO-ESGO conference consensus Frédéric Goffin

New ESGO Guidelines Management of Gynaecological Cancers Antalya, May 20th. Endometrial Carcinoma ESMO-ESTRO-ESGO conference consensus Frédéric Goffin Gynecological Oncology, Department of Gynecology & Obstetrics H ôpital de la Citadelle, Université de Liège. Endometrial Carcinoma

rhaynes
Download Presentation

Endometrial Carcinoma ESMO-ESTRO-ESGO conference consensus Frédéric Goffin

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. New ESGO Guidelines Management of Gynaecological Cancers Antalya, May 20th Endometrial Carcinoma ESMO-ESTRO-ESGO conference consensus Frédéric Goffin Gynecological Oncology, Department of Gynecology & Obstetrics Hôpital de la Citadelle, Université de Liège

  2. EndometrialCarcinoma Background (1) • Fourth most common cancer in women (Behind Breast, Lung, Colon), • Most common malignancy of the female reproductive tract • Cumulative risk is 1,7%* (Western / Developed countries) • Incidence is increasing (Aging and Obesity), • 80 % disease of postmenopausal women (More than 90%, >50 yo women) • 80 % cases are confined to the uterus (stage I disease), * WHO. GLOBOCAN 2012:

  3. EndometrialCarcinoma Background (2) • Majority of cases of EC are diagnosed at an early stage: • Most womenare curedafterhysterectomy& BSO, • Survivalrate : 80% at 5 years • 95% for stage I disease • 68% for stage III & 17 % for Stage IV diseases • EC is an heterogeneousdisease : impact prognosis, management • Manycontroversiessurrounding EC : • Classification, Surgery, adjuvant treatments, etc

  4. EndometrialCarcinoma Background (3) • Controversies reflect the paucity of high-quality data available to guide in the management • Lack of evidence results : • in discrepancies between guidelines, • a high variability in practices at all steps of the management, • in variation in the Quality of Care in comparison with guidelines

  5. EndometrialCarcinoma ESMO-ESTRO-ESGO Consensus Conference • Aim : • Need to up date the existing recommendations : • to reflect a Consensus by the scientific community (40 experts), • to be evidence-based, • from a multidisciplinary perspective • ESMO (European Society of Medical Oncology) • ESGO (European Society of Gynecological Oncology) • ESTRO (European Society of Radiation Oncology) • Consensus Conference : December 2014 • Publication in Annals of Oncology : January 2016

  6. Metastatic and Recurrent diseases (n=22) • (n=26)

  7. Metastatic and Recurrent diseases (n=22) • (n=26)

  8. LOE & GOR adapetd from Infectious Diseases Society, American-US Public Health Service Grading System

  9. LOE & GOR adapetd from Infectious Diseases Society, American-US Public Health Service Grading System

  10. Endometrial Carcinoma Consensus Conference OnlyThreeLoE I and GoR A

  11. Endometrial Carcinoma Consensus Conference • Prevention & Screening • Surgery • Adjuvant treatment • Metastatic and Recurrent diseases

  12. Endometrial Carcinoma Consensus Conference : Prevention & Screening • Which surveillance should be used for asymptomatic women? • 8 Recommendations • What work-up and management scheme for fertility-preserving therapy in patients with AH/ EIN and grade 1 EEC? • 11 Recommendations • Which (molecular) markers can help distinguish ( pre)can- cerous lesions from benign mimics? • 7 Recommendations Total of 26 recommendations

  13. Endometrial Carcinoma Consensus Conference : Prevention & Screening (1) Which surveillance for asymptomaticwomen(general population)? * : Obesity, PCOS, diabetes mellitus, infertility, nulliparity or late menopause

  14. Endometrial Carcinoma Consensus Conference : Prevention & Screening (1) With Risk Factors*

  15. Endometrial Carcinoma Consensus Conference : Fertility sparing therapy (1)

  16. Endometrial Carcinoma Consensus Conference : Fertility sparing therapy (2)

  17. Endometrial Carcinoma Consensus Conference : Fertility sparing therapy (2)

  18. Endometrial Carcinoma Consensus Conference • Prevention & Screening • Surgery • Adjuvant treatment • Metastatic and Recurrent diseases

  19. Endometrial Carcinoma Consensus Conference : Surgery • How does the medical conditions influence treatment? • 13 Recommendations • What are the indications for and to what extent is lymphadenectomy indicated in the surgical management of endometrial cancer ? • 8 Recommendations • How radical should the surgery be in different stages and pathological sub-types of EC? • 8 Recommendations no evidence for the clinical usefulness of serum tumour markers, including CA 125 Total of 29 recommendations

  20. Endometrial Carcinoma Consensus Conference : Surgery(2) Surgical management of apparent Stage I Endometrial Cancer

  21. Endometrial Carcinoma Consensus Conference : Surgery(3) Surgical management of apparent Stage I Endometrial Cancer

  22. Endometrial Carcinoma Consensus Conference : Surgery(3) Surgical management of apparent Stage I Endometrial Cancer

  23. Endometrial Carcinoma Consensus Conference : Surgery(3) Staging of Endometrial Cancer (1)

  24. Endometrial Carcinoma Consensus Conference : Surgery(3) Staging of Endometrial Cancer (1)

  25. Endometrial Carcinoma Consensus Conference : Surgery(3) Staging of Endometrial Cancer (1)

  26. Endometrial Carcinoma Consensus Conference : Surgery(3) Staging of Endometrial Cancer (2)

  27. Endometrial Carcinoma Consensus Conference : Surgery(3) Staging of Endometrial Cancer (2)

  28. Endometrial Carcinoma Consensus Conference : Surgery(3) Staging of Endometrial Cancer (2)

  29. Endometrial Carcinoma Consensus Conference : Surgery(3) Surgical Radicality (1)

  30. Endometrial Carcinoma Consensus Conference : Surgery(3) Surgical Radicality (1)

  31. Endometrial Carcinoma Consensus Conference • Prevention & Screening • Surgery • Adjuvant treatment • Metastatic and Recurrent diseases

  32. Endometrial Carcinoma Consensus Conference : Adjuvant treatment • What is the current best definition of risk groups for adjuvant therapy (low vs high-intermediate vs high risk)? • Recommendations 8.1 to 8.3 • What are the best evidence-based treatment strategies for the intermediate risk group, with/without nodal staging or LVSI and for endometrioid vs non-endometrioid cancers? • Recommendations 8.1 to 8.3 • What are the best evidence-based treatment strategies for the high-risk group, with/without nodal staging or LVSI and for endometrioid vs non-endometrioid cancers? • Recommandation 9.1 to 9.4 Total of 35 recommendations

  33. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (1) • What is the current best definition of risk groups for adjuvant therapy

  34. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (1) • What is the current best definition of risk groups for adjuvant therapy

  35. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (1) • What is the current best definition of risk groups for adjuvant therapy

  36. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (1) * Stage IA & Endometrioid & G 1-2 & LVSI negative • Stage IA & Endometrioid & G 1-2 & LVSI negative

  37. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (2) * Stage IB & Endometrioid & G 1-2 & LVSI negative

  38. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (3) • Stage IA & Endometrioid & G 3 regardless LVSI status • Stage I & Endometrioid & G1-2 & LVSI unequivocally positive (regardless of depth of invasion)

  39. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (3) • Stage IA & Endometrioid & G 3 regardless LVSI status • Stage I & Endometrioid & G1-2 & LVSI unequivocally positive (regardless of depth of invasion)

  40. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (4) • Stage IB & Endometrioid & G 3 & regardless of LVSI status

  41. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (5) • Stage IB & Endometrioid & G 3 & regardless of LVSI status

  42. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (6) * Stage III & Endometrioid & No residualdisease

  43. Endometrial Carcinoma Consensus Conference : Adjuvant treatment (7) * Non Endometrioid cancer

  44. Endometrial Carcinoma Consensus Conference • Prevention & Screening • Surgery • Adjuvant treatment • Metastatic and Recurrent diseases

  45. Endometrial Carcinoma Consensus Conference : Advanced / Metastatic Disease (1) • Has surgery or radiation any role in advanced/recurrent disease? • 1. Role of surgery • 2. Role of radioherapy • Which are the optimal systemic therapies for advanced/recurrent disease? • 1. Hormonal therapy : which p • atient and when? • 2. Chemotherapy : is there any standard of care? • What are the most promizing targeted agents and what study designs should be used to evaluated their clinical benefit? • 1. Molecular alterations in endoemtrial cancer potentially druggable • 2. New agents in recurrent or metastatic EC Total of 22 recommendations

  46. EndometrialCarcinoma Consensus Conference : Advanced / MetastaticDisease (1)

  47. EndometrialCarcinoma Consensus Conference : Advanced / MetastaticDisease(2)

  48. EndometrialCarcinoma Consensus Conference : Advanced / MetastaticDisease(3)

  49. EndometrialCarcinoma Consensus Conference : Advanced / MetastaticDisease(4)

More Related