A 72-year-old woman presents with postmenopausal bleeding. Endometrial biopsy shows Grade 2 endometrioid adenocarcinoma. MRI staging shows invasion into the outer half of the myometrium without cervical involvement. There is no lymphadenopathy. FIGO stage is IB. What is the RECOMMENDED adjuvant treatment?

• A Observation alone (no adjuvant treatment needed)
• B External beam pelvic radiotherapy plus vaginal brachytherapy
• C Vaginal brachytherapy alone ✓
• D Systemic chemotherapy with carboplatin-paclitaxel

Explanation

For Stage IB (outer half myometrial invasion) Grade 1–2 endometrioid carcinoma (intermediate risk), vaginal brachytherapy alone reduces vaginal vault recurrence with less toxicity than pelvic external beam radiation. The PORTEC-2 trial demonstrated equivalence of vaginal brachytherapy versus external pelvic RT for local control in intermediate-risk endometrial cancer. EBRT plus brachytherapy is reserved for high-intermediate or high-risk cases (Grade 3, LVSI, lymph node involvement).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.