A 52-year-old post-menopausal woman presents with stage IA grade 2 endometrioid endometrial carcinoma (FIGO 2009), <50% myometrial invasion. Sentinel lymph node biopsy is negative. Which is the CURRENT evidence-based management according to ESGO/ESTRO/ESP 2020 guidelines?

• A Observation alone — low-risk disease; vaginal brachytherapy adds no survival benefit
• B Vaginal brachytherapy only — reduces vaginal recurrence rate without requiring external beam RT ✓
• C External beam pelvic radiotherapy (EBRT) — required for grade 2 disease with any invasion
• D EBRT + concurrent chemotherapy — chemoradiation is now standard for all stage I disease

Explanation

According to ESGO/ESTRO/ESP 2020 guidelines, Stage IA grade 2 endometrioid carcinoma with < 50% myometrial invasion is classified as intermediate risk. PORTEC-1 and GOG-99 trials established that vaginal brachytherapy (VBT) reduces vaginal relapse rate (from ~15% to ~2%) without improving overall survival compared to observation. PORTEC-2 showed VBT equivalent to EBRT for vaginal control in intermediate-risk disease with less toxicity. VBT is therefore the preferred adjuvant treatment for intermediate-risk endometrial cancer. Observation alone is appropriate for low-risk (stage IA, grade 1, <50% invasion, favorable histology, no LVSI).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.