In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?

Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.

Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...

In cases where a RUBY or 018 regimen is recommended for a patient outside the true inclusion criteria (NCCN lists them both as viable options for all stage III with the residual disease qualifier being relegated to a footnote and insurance seems to be playing along), I, at a minimum, push for vagina...

GY018 was for stage III with measurable disease for endometrium histology and not truly adjuvant while RUBY allowed stage III2 endometroid adjuvant but was a small subset (18% or so) and pre-specified stratification didn’t reach PFS benefit in that subset. So in a true sense, it’s more for R2 stage ...

Update:

With the publication of GOG-3053 showing no benefit to IO in the pMMR population, I still advocate for ERBT+VBT in those patients with or without residual disease. If dMMR, I typically only recommend VBT unless there is a compelling reason for EBRT, like positive margin/residual disease or he...