When, if ever, would you offer adjuvant radiation to a patient with stage IVB endometrial cancer following neoadjuvant chemotherapy and cytoreductive surgery?

Stage IVB can have a large spectrum based on the extent and volume of metastatic disease. The NCDB dataset has lots of selection bias in who gets EBRT and also no data on DFS or recurrence pattern. I have usually avoided adjuvant RT unless pelvis is only confined to stage IVB disease.

The linked database study suggests that RT + chemotherapy is more effective than chemo alone. There is likely a subset of patients with limited disease who may benefit from an aggressive local therapy approach.

There are a number of unknowns that are reported in at least NCDB that were not looked int...