A woman with FIGO stage IC (deep myometrial invasion >50%) grade 3 endometrioid endometrial carcinoma, no cervical or adnexal involvement, negative lymph nodes on staging, no LVSI: what does ESMO/ESGO 2020 recommend for adjuvant therapy?

• A Chemotherapy (carboplatin-paclitaxel) ± pelvic EBRT based on high-risk features ✓
• B Vaginal brachytherapy alone — sufficient for local control
• C Pelvic external beam radiotherapy (EBRT) alone
• D Pelvic EBRT + vaginal brachytherapy (VBT) without chemotherapy

Explanation

ESMO/ESGO 2020 endometrial cancer guidelines classify stage IC grade 3 (deep invasion + high-grade) as HIGH-INTERMEDIATE risk. For high-risk early-stage endometrial cancer (stage I grade 3 with deep myometrial invasion), adjuvant treatment includes chemotherapy (carboplatin-paclitaxel, 4–6 cycles) with or without pelvic EBRT, or EBRT + VBT. The evidence from PORTEC-3 and GOG 258 supports combined chemo-radiotherapy in high-risk early-stage disease showing improved disease-free survival. VBT alone is insufficient for grade 3 deep invasion.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.