How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?

PET CT staging.

If suitable for definitive treatment, EBRT (concurrent chemo if able to get it) plus HDR brachytherapy.

I would send genomics and immediately initiate carboplatin/paclitaxel plus or minus bevacizumab (or Herceptin if UPSC Her2 over expressor). Judge response along the way. Oftentimes, response is tremendous and primary surgery can be entertained. Review CT carefully and address any bulky nodes on followup scans and at surgery, but oftentimes these resolve as well. For non responders or only partial responders, RT with brachy is always available, but I personally prefer a chemo-surgical approach fo...

The combination arm of PORTEC-3. Assess for distant disease.