Treatment for Intermediate Risk Endometrial Cancer

Surgical Management

The European Society for Medical Oncology recommends total hysterectomy with bilateral salpingo-oophorectomy as the standard surgical approach for intermediate risk endometrial cancer, with lymphadenectomy considered for staging purposes 1, 2, 3
Lymphadenectomy can be considered for staging purposes, with sentinel lymph node dissection (SLND) being an option, as recommended by the European Society for Medical Oncology 1, 2
Minimally invasive surgery (laparoscopic or robotic) is recommended for intermediate-risk endometrial cancer by the European Society for Medical Oncology 1

The European Society for Medical Oncology recommends adjuvant vaginal brachytherapy as the recommended treatment for intermediate risk endometrial cancer 1, 2
No adjuvant treatment is an option, especially for patients <60 years old, as suggested by the European Society for Medical Oncology 1
For cases with G3 histology or unequivocally positive LVSI, adjuvant chemotherapy (combined and/or sequential) should be considered by the European Society for Medical Oncology 1

The PORTEC-2 trial demonstrated that vaginal brachytherapy is as effective as external beam radiation for intermediate risk patients, but with better quality of life, as reported in the Annals of Oncology 3
External beam radiation has been shown to reduce locoregional recurrence but does not improve overall or disease-specific survival, according to the Annals of Oncology 3
Three large randomized studies (PORTEC-1, GOG 99, and ASTEC MRC-NCIC CTG EN.5) failed to demonstrate survival improvement with external beam radiation, as reported in the Annals of Oncology 3

For patients with specific risk factors, the European Society for Medical Oncology recommends vaginal brachytherapy for G1-2 tumors with negative LVSI, and limited field external beam radiotherapy (EBRT) for G3 tumors or positive LVSI 1
If G3 or LVSI unequivocally positive, the European Society for Medical Oncology suggests considering adjuvant chemotherapy (combined and/or sequential) 1, 2

Overtreatment with external beam radiation when vaginal brachytherapy would suffice for intermediate risk disease is a common pitfall, as noted in the Annals of Oncology 3
Underestimating the importance of surgical staging for guiding adjuvant therapy decisions is a caveat, as emphasized by the European Society for Medical Oncology 1
Failing to consider age and comorbidities when deciding on adjuvant therapy options is a pitfall, as highlighted by the European Society for Medical Oncology 1
Not recognizing that patients with G3 histology or positive LVSI may benefit from more aggressive adjuvant treatment approaches is a caveat, as noted by the European Society for Medical Oncology 1