How would you manage a patient with FIGO 2018 IA G3 endometrioid adenocarcinoma with substantial LVSI, and was N- with adequate nodal staging?
Would you consider VBT alone vs EBRT and/or offer chemo?
This is a female in her late 60s with FIGO 2023 IIB disease given substantial LVSI+ (>5 vessels), and has the following molecular profile (NSMP): MMRp, ER+, p53 wild-type, POLE(-), TMB low, MSS.
Answer from: Radiation Oncologist at Academic Institution
The main (IMO) extensive LVSI literature and associated elevated risks of pelvic nodal recurrence (Bosse et al., PMID 26049688) are from a pooled analysis of the PORTEC-1 and PORTEC-2 trials.Neither trial routinely did lymphadenectomy, just a biopsy of suspicious nodes. PORTEC-2 explicitly excluded ...
Comments
Radiation Oncologist at Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches
Great arguments! Lower uterine segment involvement...
Great arguments! Lower uterine segment involvement...
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
There is wide variation in practice between treati...
There is wide variation in practice between treati...
Answer from: Radiation Oncologist at Community Practice
I would favor pelvic IMRT (or proton therapy) with a vaginal cuff HDR boost. Based on considerable data, including the PORTEC studies, substantial lymphovascular invasion is an independent predictor of local-regional recurrence.
Comments
at BayCare Medical Group
PORTEC subanalyses also indicate IMRT/EBRT is usua...
PORTEC subanalyses also indicate IMRT/EBRT is usua...
Answer from: at Community Practice
If p53 is aberrant, I tend to treat Grade 3 as I would uterine serous. That is, chemotherapy is likely the workhorse of the treatment regimen. In this case, given p53 wild type, I think vaginal brachytherapy is appropriate here.
Since SNLN has a high negative predictive value, I...
I would recommend pelvic RT followed by a vaginal ...