AROI-ESTRO GYN Teaching Course

Why the entire uterus?

Rationale

• Uterus & cervix: embryological one unit – interconnected lymphatics – no separating fascial plane • Challenging to determine myometrial invasion • Trachelectomy, early stage disease a : – Local recurrence < 5 %, Mortality < 3% – Uterine recurrences b,c,d 2 % • Trachelectomy, tumor > 2 cm or lymphovascular invasion a,e : – Local recurrence up to 10 %

• Allowing for some dose reduction to the fundus in cases without uterine infiltration will be investigated in future

c Diaz JP, et al. Gynecol Oncol 2008 d Hertel H, et al. Gynecol Oncol 2006 e Nishio H, et al. Gynecol Oncol 2009

Lim K, et al. IJROBP 2010 a Plante M. Gynecol Oncol 2008 b Bali A, et al. Gynecol Oncol 2008