Locoregional Recurrent Endometrial Carcinoma in Patients Previously Treated with Radiotherapy
Clinical Scenario
Locoregional Recurrence · Prior Radiotherapy
This protocol addresses patients with locoregional recurrence of endometrial carcinoma who have previously received adjuvant radiotherapy — either brachytherapy alone, or external beam radiotherapy (EBRT) with or without brachytherapy.
The prior radiotherapy history defines the available options at recurrence and determines how the multidisciplinary team approaches both local and systemic strategies.
How Prior Radiotherapy Shapes Management
After prior adjuvant brachytherapy only, locoregional recurrence can be addressed with a combination approach that includes EBRT and an image-guided brachytherapy boost.
After prior EBRT (with or without brachytherapy), the tumour's molecular subtype becomes a key factor in deciding between radical surgery or systemic approaches — including therapies that target specific molecular characteristics of the tumour.
Treatment Approach (Overview)
When surgery is not feasible, the recommended approach involves primary systemic therapy guided by the tumour's molecular profile — the specific agents and sequencing depend on molecular subgroup. Re-irradiation may also be considered in a specialised centre for select patients previously treated with EBRT. Full regimen details, eligibility criteria, sequencing, and molecular subgroup guidance are available in the complete protocol…
References
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).
- If radical surgery is not feasible, primary systemic therapy should be considered, considering the molecular profile (IV, B; appendix p 15).
- Re-irradiation with curative intent could be considered in a specialised centre for patients with previous external beam radiotherapy for whom surgery is not feasible (IV, C; appendix p 15).
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