Would uterine serosal involvement change your adjuvant treatment recommendation for a patient with Stage II grade 2 endometrial cancer?

Would recommend chemotherapy and vaginal brachytherapy.

Had the patient had Stage II, Grade 2 disease (ignore the ITC for a moment), we would offer the patient pelvic radiation therapy alone based on GOG 249 and PORTEC 3 results, the latter of which showed a benefit of chemotherapy largely driven by IIIC and serous patients. Pelvic radiation for Stage II disease is often accompanied by a vaginal brachytherapy boost, acknowledging boost has not been independently tested in high level fashion.

With...

Serosal involvement in endometrial cancer upstages a patient to Stage IIIA. Despite a likely risk of recurrence in the pelvis/vagina for a cancer that involves the cervix, the standard of care for this stage is chemotherapy. Some, however, might include radiation therapy either in a sandwiched approach or before/after chemo is complete. There are several trials exploring these patients but perhaps the most relevant is that published by Matei et al 2020. On this trial of 813 patients randomized t...