A 62-year-old postmenopausal woman undergoes total abdominal hysterectomy with bilateral salpingo-oophorectomy for FIGO Stage IB grade 2 endometrioid adenocarcinoma. Final pathology shows tumor invading 60% of myometrial thickness, no cervical involvement, negative adnexa and lymph nodes, and no lymphovascular space invasion. According to current ESGO/ESP guidelines, what is the recommended adjuvant therapy?

• A No additional therapy, surveillance only
• B External beam pelvic radiotherapy
• C Vaginal cuff brachytherapy ✓
• D Chemotherapy with carboplatin and paclitaxel

Explanation

Stage IB grade 2 with no LVSI and negative nodes places this in the intermediate-risk group by ESGO/ESP. The PORTEC-2 trial established vaginal cuff brachytherapy as equivalent to external beam pelvic RT for intermediate-risk disease with fewer side effects. Pelvic RT is reserved for high-risk features (stage II or grade 3 with deep invasion). Chemotherapy is used for stage III-IV or serous/clear cell histologies. Surveillance alone is insufficient given the grade 2 and deep invasion.

Reference: Williams Gynaecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.