Treatment of Low-Risk Endometrial Carcinoma: Molecular Stage IAm to IIm (POLEmut, MMRd, NSMP)
This protocol addresses the management of endometrial carcinoma classified as low risk, defined by a combination of molecular subtype and pathological stage. Identifying the correct risk category based on molecular and staging criteria determines whether any further therapy beyond surgery is required.
Who this applies to
Low-risk classification applies to four distinct groups:
- Stage IAm (IA1, IA2, or IA3) endometrial carcinoma that is POLEmut, MMRd, or NSMP low-grade and oestrogen receptor-positive
- Stage IBm endometrial carcinoma that is POLEmut
- Stage ICm endometrial carcinoma that is POLEmut or MMRd
- Stage IIm (IIA, IIB, or IIC) endometrial carcinoma that is POLEmut
Treatment approach
The standard surgical approach — performed by a minimally invasive route — forms the cornerstone of management, with lymph node assessment included for staging. Once surgery is complete, the question of whether additional treatment is needed is addressed by the full protocol…
The complete regimen, decision algorithm, and all clinical criteria are in the full protocol.
References
DOI: 10.1016/S1470-2045(25)00167-6
- Low risk includes four categories (figures 3, 4; green cells).
- First, stages IA molecular (m; IA1, IA2, or IA3) POLEmut, MMRd, or NSMP low-grade and oestrogen receptor-positive endometrial carcinoma.
- Second, stage IBm POLEmut endometrial carcinoma.
- Third, stage ICm POLEmut or MMRd endometrial carcinoma.
- Fourth, stages IIm (IIA, IIB, or IIC) POLEmut endometrial carcinoma.
- Standard surgery for stage I and II endometrial carcinoma is total hysterectomy with bilateral salpingo-oophorectomy and lymph node staging (II, A for stage I and IV, B for stage II).
- Minimally invasive surgery is the preferred surgical approach, including for patients with high-risk endometrial carcinoma (I, A).
- Sentinel lymph node biopsy should be done for staging purposes in all patients with presumed uterus-confined disease (II, A).
- For patients with low-risk endometrial carcinoma, no adjuvant therapy is recommended (II, A; figure 5).
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