How would you manage a patient in her 50s with FIGO IA clear cell carcinoma of the endometrium with extensive LVSI and ITCs in an obturator node after 6 cycles of carbo/taxol?

I would favor EBRT plus brachy boost.

Here is a review and our treatment philosophy Musunuru et al., PMID 35248784

Vaginal brachytherapy for our practice, in addition to the chemo.

We understand that patients with extensive LVSI have probably poorer outcomes, but we're not sure that pelvic radiation (or more intensive chemo in the same vein) can 'rescue' these outcomes. ITCs are treated as pN0. I would guess tha...

Typically, we relied on GOG249 or PORTEC-3 trials, and depending on which camp one falls - patients would receive chemo + brachy or pelvic RT. But that may not be the case anymore.

The landscape of adjuvant treatment is changing with the incorporation of molecular markers into staging of such patient...

Presumably, the patient has had a pelvic SLNB bilaterally given the ITCs.

The risk of pelvic recurrence being high in PORTEC trials in extensive LVSI patients was likely, at least in part, due to unsampled micrometastatic disease given the lack of use of regular lymphadenectomy in European practice ...

Pelvic RT to 45 Gy.

I would offer WP radiation but no brachytherapy boost. I would also want to know the P53 status. Some clear cell carcinomas are more aggressive than others and this histology should be viewed as a heterogeneous one and not necessarily identical to serous cancers. There is also the question of lack o...

I agree that the patient will benefit from the external beam radiation therapy to whole pelvis as well as vagina brachytherapy to reduce the recurrence of the apex of the vagina. As the patient has a higher chance of distant meta states, I would also add chemotherapy.