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

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 ...

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...

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