What, if any, adjuvant treatment do you offer a a patient with stage I clear cell endometrial carcinoma?

Clear cell carcinoma is a rare tumor with sparse literature regarding its adjuvant treatment. There is a recent SGO review article on this topic that is a nice reference. For stage I uterine clear cell, there are no prospective studies to study the impact of adjuvant chemotherapy and/or radiation. However, I would treat with adjuvant chemotherapy given that this is high-risk histology after discussing with the patient the limitations of our knowledge in this rare tumor. I would discuss the risks and benefits of adjuvant radiation. For a well-staged patient with no disease found on the hysterectomy specimen, I would consider observation in this case.

Olawaiye and Leath 3rd, PMID 31500893.