Do the number of lymph nodes removed in a non-Stage IA/FIGO 1 endometrial cancer case, affect your decision for WPRT v. vaginal brachytherapy alone?

Yes, in some cases it does—for two reasons. If a patient has had an extensive negative node dissection, the risk of extravaginal pelvic failure is undoubtedly less and the risk of RT complications may also be greater than if the patient had hysterectomy only. These factors define the “therapeutic gain” that can be influenced by many factors including the number of negative nodes examined.

A negative lymphadenectomy definitely causes us to lean away from pelvic RT for patients whose cancers fall in the lower risk end of the GOG-99 high-intermediate risk group—for example a 70 year old woman with 50% invasion, grade 2 and no LVSI. On the other hand, we still usually offer pelvic RT to those in the highest risk categories—e.g., 80% invasion, gr...