A 52-year-old woman with stage IA grade 1 endometrioid endometrial carcinoma (FIGO 2023) undergoes surgical staging with no lymphovascular space invasion (LVSI). According to ESGO/ESTRO/ESP 2020 risk stratification, she falls in which risk group, and what adjuvant treatment is recommended?
- A Intermediate risk — vaginal brachytherapy recommended
- B High-intermediate risk — external beam radiotherapy recommended
- C Low risk — no adjuvant treatment needed, surveillance only ✓
- D High risk — chemotherapy with carboplatin/paclitaxel recommended
Explanation
ESGO/ESTRO/ESP 2020 guidelines classify endometrial carcinoma by molecular and histopathological features. Stage IA (confined to endometrium/inner half of myometrium) grade 1 endometrioid with no LVSI and no adverse molecular features (NSMP or MSI-H) is classified as LOW RISK. Low-risk patients require no adjuvant treatment — surveillance alone is recommended. Vaginal brachytherapy is indicated for high-intermediate risk (Stage I grade 3, or Stage IA with LVSI, etc.). External beam radiotherapy and chemotherapy are for high-risk/advanced disease. The ProMisE/molecular sub-classification is now integral to these risk stratification decisions.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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