Locoregional recurrence of endometrial carcinoma following prior radiotherapy presents a distinct management challenge. The treatment approach depends critically on which type of radiotherapy was previously delivered.
The protocol distinguishes between two prior-treatment histories. When only adjuvant brachytherapy was previously given, an additional radiation-based approach may be employed at recurrence. When prior external beam radiotherapy was part of the prior treatment, management considers molecular subtype and may involve surgical or systemic options — including immune checkpoint inhibitor-based strategies for eligible patients.
Full regimen details, sequencing, and eligibility criteria are in the complete protocol →
DOI: 10.1016/S1470-2045(25)00167-6
After previous adjuvant brachytherapy only, an external beam radiotherapy and image-guided brachytherapy boost is recommended (IV, C).
After previous external beam radiotherapy (with or without brachytherapy), the molecular subtype should be considered in the decision making about radical surgery (IV, A) or chemotherapy and immune checkpoint inhibitors, followed by immune checkpoint inhibitors in patients with MMRd tumours who are immune checkpoint inhibitor-naive (II, B).
Radical surgery should only be done if complete resection with clear margins in a curative intent seems feasible with acceptable morbidity (IV, A).
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