How does number of ITC influence your approach to adjuvant RT for a surgically staged 1B endometrial cancer meeting HIR criteria?

Management of ITC only in the setting of SNLN is not defined well.

We know ITC has a much better prognosis than micromets and macromets.

We also know that even with ITC after SNLN bx only, there is risk of additional residual nodal disease left behind which may need to be addressed.

What we don’t know is whether we need to treat for that additional risk with RT, surgery, or none.

Our approach if there is an adverse intrauterine factor like deep myometrial involvement, high grade or LVSI, we con...

While the presence of ITCs alone does not change my practice, I try to look at that in the context of the big picture. The first thing that I do is to make sure the pathology diagnosis is correct which sometimes leads me to get a second review on the pathology. If this were upstaged to micromets, then that would change the treatment.

For this patient with MELF pattern, deep myometrial invasion, LVSI, and ITCs, I would favor adjuvant whole pelvic RT.

With or without the ITC's, this patient is categorized as high intermediate risk per GOG 249 (age 73, with at least one risk factor--deep invasion, and positive LVSI). Given this alone, she would merit post operative adjuvant radiation therapy. Given the MELF and ITC, I would advocate for pelvic RT rather than brachytherapy.

Also, are you sure that 47 ITC's in a single lymph node doesn't meet the criteria for at least micro mets (> 0.2 mm)?