A 58-year-old woman with FIGO Stage II endometrial carcinoma (cervical stromal invasion, no extrauterine disease) undergoes radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Which factor most strongly indicates need for adjuvant chemoradiation rather than radiation alone?

• A Age over 60 years
• B Positive pelvic lymph nodes ✓
• C Tumor size greater than 4 cm
• D Presence of lymphovascular space invasion

Explanation

Positive lymph nodes upstage the disease to Stage IIIC1, which is high-risk requiring chemotherapy in addition to radiation. The PORTEC-3 and GOG-258 trials showed benefit of chemoradiation in stage III disease. While LVSI and large tumor size are adverse features, they alone do not mandate combined chemoradation for stage II. Age is not a primary determinant of adjuvant treatment modality in current guidelines.

Reference: Williams Gynaecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.