When stage I or II endometrial carcinoma is diagnosed in a patient whose medical comorbidities carry high operative and perioperative risks, standard surgical management may not be appropriate. Curative intent can still be pursued through carefully selected alternatives — the choice of approach depends on the individual patient's clinical situation.
Stage I and II endometrial carcinoma in patients with medical comorbidities for whom standard surgery is precluded due to high operative and perioperative risks.
Vaginal hysterectomy with bilateral salpingo-oophorectomy, if feasible, can be considered as a curative option in patients unfit for the recommended standard surgical therapy (patients with medical comorbidities for whom standard surgery is precluded due to high operative and perioperative risks; IV, C).
Definitive curative radiotherapy is the treatment of choice in patients with a primary endometrial carcinoma diagnosis in whom standard surgery is contraindicated for medical reasons.
The combination of external beam radiotherapy plus intrauterine image-guided brachytherapy should be used for high-grade tumours or deep myometrial invasion or both (II, B).
For low-grade tumours without deep myometrial invasion, intrauterine image-guided brachytherapy alone can be considered as an alternative for the combination of external beam radiotherapy plus intrauterine image-guided brachytherapy (II, B).
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