How would you treat a high intermediate risk stage IA grade 2 endometrial ca?

If the patient had high risk features (for example age 60+ and LVI) do you treat with vaginal brachytherapy or WPRT? If you treat with whole pelvis radiation, is there any indication for the addition of chemotherapy?

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How do you treat a stage IA grade 2 endometrial cancer without nodal assement, myometrial invasion, age 60+, and presence of LVI

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3 Answers

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Radiation Oncology · Abramson Cancer Center, University of Pennsylvania

Answered on

If it is Stage IA, Grade 2 without additional risk factors, we recommend observation. It is not considered high intermediate risk.

If it is Stage IA, Grade 2 with additional risk factors such as LVI or age 60+, we recommend a referral to radiation oncology to discuss. Anecdotally, most patients will ...

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Radiation Oncology · Med Univ of South Carolina

Answered on

In general, I would offer vaginal brachytherapy. I like to use the PORTEC-1&2 nomogram (Creutzberg et al., IJROBP 2015) when discussing treatment options with patients. For example, with a 60 year old with IA, grade 2 and LVI, the risk of LRR with observation would be ~ 12-13%; with vaginal brachyth...

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Radiation Oncology · Varian Medical Systems/Allegheny health network

Answered on

Brachytherapy alone unless has substantial LVSI or p53 mutation then would consider adding EBRT especially if nodes not sampled. Chemotherapy is for p53 mutation positive.
Concin et al., PMID 33397713

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