Endometrial cancer
ICD-10 C54.1 · ICD-11 2C76

Treatment of Endometrial Carcinoma Classified as Intermediate Risk (Stages IBm, IIAm, IICm)

This protocol addresses adjuvant management for patients with endometrial carcinoma whose tumour and staging characteristics place them in the intermediate-risk category — a group defined by a specific combination of molecular profile, grade, stage, and lymphovascular features.

Clinical Scenario

Intermediate risk encompasses three distinct categories:

  • Stage IBm with MMRd or NSMP molecular profile, low grade, and oestrogen receptor-positive status
  • Stage IIAm with NSMP molecular profile, low grade, and oestrogen receptor-positive status
  • Stage IICm with MMRd profile and myoinvasion (regardless of depth), absent cervical stromal invasion, and without substantial lymphovascular space involvement

Adjuvant Approach — Partial Overview

A localised adjuvant radiation approach is the primary treatment consideration for intermediate-risk disease. For selected patients — particularly those who are younger or have low-grade tumours — omitting adjuvant therapy altogether may also be appropriate.

The complete structured regimen, including all options, selection criteria, and evidence grades, is available via the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/S1470-2045(25)00167-6

  • Intermediate risk includes three categories (figures 3, 4; yellow cells).
  • First, stage IBm MMRd or NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
  • Second, stage IIAm NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
  • Third, stage IICm MMRd endometrial carcinoma with myoinvasion (regardless of depth of myometrial invasion), without cervical stromal invasion and without substantial lymphovascular space invasion.
  • For patients with intermediate-risk endometrial carcinoma, adjuvant vaginal brachytherapy should be considered (I, A).
  • No adjuvant therapy is also an option (III, C), especially for patients younger than 60 years or those with low-grade endometrial carcinoma (II, A; figure 5).
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