Treatment of Endometrial Carcinoma Classified as High-Intermediate Risk
High-intermediate risk endometrial carcinoma is a defined clinical category in which tumour stage is assessed alongside molecular classification and histological features. Adjuvant management in this group depends on the specific combination of these factors identified at diagnosis.
Clinical Scenario
This protocol applies to endometrial carcinoma classified as high-intermediate risk, covering three distinct subgroups:
- Stage IIAm with mismatch repair deficiency (MMRd)
- Stage IIBm with MMRd, or NSMP low-grade and oestrogen receptor-positive
- Stage IICm with MMRd and cervical invasion (independent of lymphovascular space invasion), or with substantial lymphovascular space invasion
Adjuvant Treatment Approach
For this risk group, adjuvant locoregional radiotherapy plays a central role in achieving optimal pelvic control. The choice of radiotherapy modality is guided by surgical staging findings, nodal status, and tumour characteristics. In selected patients with favourable pathological findings, an alternative radiotherapy approach may be preferred. In certain well-defined circumstances, a strategy without adjuvant therapy is also a recognised option.
The complete regimen, decision criteria, and full algorithm are available in the structured protocol.
References
DOI: 10.1016/S1470-2045(25)00167-6
- High–intermediate risk includes three categories (figures 3, 4; orange cells).
- First, stage IIAm MMRd endometrial carcinoma.
- Second, stage IIBm MMRd, or NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
- Third, stage IICm MMRd endometrial carcinoma with cervical invasion (independent of lymphovascular space invasion) or with substantial lymphovascular space invasion.
- For patients with high–intermediate-risk endometrial carcinoma, adjuvant external beam radiotherapy is recommended for optimal pelvic control (II, A).
- Vaginal brachytherapy is an alternative option, especially for patients who underwent lymph node staging and are pN0 (II, B).
- No adjuvant therapy can be considered, especially for patients who underwent lymph node staging and are pN0 without substantial lymphovascular space invasion and low-grade disease (IV, B; figure 5).
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