This protocol addresses patients with stage I or II endometrial carcinoma who carry significant medical comorbidities that pose high operative and perioperative risks, making standard surgical management unsuitable.
In patients unfit for standard surgery, curative-intent options such as vaginal hysterectomy (where feasible) or definitive radiotherapy may be considered. Where these approaches are also contraindicated or not tolerated, the focus shifts to palliative management.
For patients medically unsuitable for any curative-intent treatment, palliation may involve systemic therapy — including endocrine-based approaches — or a combination of local interventions. The full protocol details the specific options, their sequencing, and the evidence behind each choice.
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.
For patients who are medically unfit and are unsuitable for treatment with curative intent (standard surgery, vaginal hysterectomy, or definitive radiotherapy), systemic treatment (including endocrine therapy), a combination of local treatments (including a progestin-releasing intrauterine device and radiotherapy), or both, can be considered for palliation (IV, B; appendix pp 11, 25, 26).
DOI: 10.1016/S1470-2045(25)00167-6
View source ↗