**4.8 Advanced disease**

There is no agreement on the standard treatment for women with advanced endometrial cancer. A combination of optimally debulked, radiotherapy and chemotherapy is employed. Metastatic endometrial cancer can be effectively treated with progestational agents. Response rates ranged from 40% with grade 1 disease and 0% with Broder's grade 4 lesions. [Podratz, 1985]. ESMO recommended hormonal therapy for endometrioid histologies only with overall response 25% [Colombo, 2011]. Chemotherapy alone determines a response rate of 40%. The most commonly used are compounds, antracyclines and taxanes, alone and in combination. Paclitaxel-based combination regimens are preffered for first-line chemotherapy of advanced endometrial cancer. The consistent response rate was only for paclitaxel>20% [Colombo, 2011]. The paclitaxelcontaining regimens demonstrated a response rate > 60% and a possibly prolonged survival. GOG shows that patients with metastatic endometrial carcinoma require pelvic irradiation with or without paraaortic irradiation, followed by cisplatin, doxorubicin and paclitaxel (Randall, 2006).
