Metastatic Ca Endometrium

High risk of recurrence in Limited disease

1. deep myometrial invasion,
2. grade 3 disease,
   
3. high-risk cellular histologic types(serous or clear cell)

Solitary metastatic lesions that are amenable to radiation with or without surgical resection.

1. vaginal recurrences who have not received radiation can be treated with radiation,with complete response rates of 40% to 81%
   
2. Small central pelvic recurrences within a radiated field may be cured with pelvic exenteration.
3. Isolated metastasis to the lung parenchyma, brain, or liver

Targetted therapy --

1. mTOR Inhibitors,
2. Bevacizumab,
3. trastuzumab
4. Antagonists to EGFR include small molecule tyrosine kinase inhibitors (gefitinib, erlotinib, and lapatinib) and the anti-EGFR monoclonal antibody cetuximab.
   

Conclusions
Women with metastatic endometrial cancer have an overall poor prognosis, with survival estimates of less than 1 year. Patients who are chemotherapy-naive with a good performance status should be treated with combination chemotherapy. A combination of paclitaxel, doxorubicin, and cisplatin has shown the highest overall response rates to date. In women with multiple medical comorbidities, single-agent chemotherapy may be better tolerated with acceptable results. Hormonal therapy should be considered in women with lowgrade tumors and/or in women with a poor performance status because of the low associated morbidity of treatment.