Clinical Research on Moderately Hypofractionated Adaptive Postoperative Radiotherapy for High-Risk Endometrial Cancer

Research Process

• Baseline Assessment Includes medical history inquiry, physical examination, and relevant laboratory/imaging tests. Complete the pre-radiotherapy Quality of Life Scale.
• Treatment Plan

External Beam Radiotherapy (EBRT): Utilize online adaptive radiotherapy technology to irradiate the vagina and pelvic lymph node drainage areas. Employ moderate fractionation. Prescription Dose: 40.05 Gy / 15 fractions, administered once daily, five times per week.

Brachytherapy: Commence after completion of EBRT. Utilize 3D intracavitary brachytherapy technology. Fraction Dose: 4-6 Gy, for a total of 2-3 fractions, administered with an interval of 1-2 days between fractions.

• Follow-up Visits

• During Radiotherapy: Monitor CBC weekly and Biochemistry Panel every 2 weeks. Perform radiotherapy-related toxicity assessment.
• Post-Radiotherapy:

Timepoints: End of radiotherapy; 3 months post-radiotherapy; 6 months post-radiotherapy; then every 6 months thereafter, until 3 years post-radiotherapy.

Follow-up Content: Includes medical history inquiry, physical examination, and Quality of Life assessment; Laboratory/Imaging Tests.

Inclusion criteria

• Age : 18-70 years old.
• Performance Status :

ECOG score 0-2.

• Expected to comply with oART (Online Adaptive Radiotherapy) workflow.
• Initial Surgical Treatment :

Total hysterectomy and bilateral salpingo-oophorectomy ± Pelvic and/or para-aortic lymph node dissection/sampling or sentinel lymph node biopsy.

• Pathological Staging & Histology (per FIGO 2009):

Stage I :

Grade 3 endometrioid adenocarcinoma with superficial myometrial invasion and extensive LVSI (Lymphovascular Space Invasion).

Grade 2 endometrioid adenocarcinoma with deep myometrial invasion and extensive LVSI.

Grade 3 endometrioid adenocarcinoma with deep myometrial invasion. Stage II-IIIC1 : Endometrioid carcinoma. Stage I-IIIC1 : Serous carcinoma or clear cell carcinoma.

• Informed Consent :
• Patients and families fully understand the study protocol.
• Voluntarily participate and sign informed consent forms before enrollment

Exclusion criteria

• Prior Radiotherapy : History of abdominal or pelvic irradiation.
• Treatment Interval :

Without adjuvant chemotherapy: >12 weeks between surgery and radiotherapy initiation.

With adjuvant chemotherapy: >6 months between surgery and radiotherapy initiation.

• Malignancy History : Prior diagnosis of other malignancies.
• Pregnancy/Lactation : Pregnant or breastfeeding women.
• Active Infection : Fever or uncontrolled active infection.
• Inflammatory Bowel Disease (IBD) : History of IBD (regardless of activity status).
• Comorbidities : Severe conditions affecting trial compliance, including: Unstable cardiac disease requiring treatment, renal impairment, chronic hepatitis, poorly controlled diabetes, psychiatric disorders