A 55-year-old woman with FIGO Stage IB (myometrial invasion >50%) grade 2 endometrioid adenocarcinoma, LVSI positive, undergoes total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. All lymph nodes are negative. Which adjuvant therapy is MOST appropriate based on current evidence?

• A Observation only
• B Pelvic external beam radiotherapy ✓
• C Vaginal cuff brachytherapy alone
• D Adjuvant chemotherapy with carboplatin and paclitaxel

Explanation

This patient has high-intermediate risk features (deep myometrial invasion >50%, LVSI positive, grade 2). PORTEC-2 established vaginal brachytherapy for high-intermediate risk, but LVSI positivity and deep invasion favour pelvic EBRT to reduce pelvic recurrence. PORTEC-1 showed pelvic EBRT reduces locoregional recurrence in Stage I high-risk disease. Observation is insufficient given these risk factors. Chemotherapy alone is not standard adjuvant for node-negative Stage I disease without distant metastases.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.