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Latest Guidelines for Managing Endometrial Carcinoma: ESGO Consensus Conference

Discover the latest updates on endometrial carcinoma management based on ESGO's consensus conference for evidence-based recommendations by 40 experts. Get insights on prevention, screening, surgery, adjuvant treatments, and more to improve patient care.

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Latest Guidelines for Managing Endometrial Carcinoma: ESGO Consensus Conference

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  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)

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