Adjuvant chemotehrapy
For G1, stage Ia NCCB recommends: Observation preferred
or
Consider vaginal brachytherapy if lymphovascular space invasion (LVSI)
and/or age =60
Adjuvant therapy recommendations have traditionally been based on the individual patient’s risk of disease recurrence using clinicopathologic factors such as age, stage, histologic subtype, tumor grade, and lymphovascular space invasion (LVSI) In particular, the ESMO/ESGO/ESTRO (European Society for Medical Oncology–European Society for Radiotherapy and Oncology–European Society of Gynaecological Oncology) consensus in 2016 proposed five risk groups to guide adjuvant therapy use (low, intermediate, high-intermediate, high, advanced/metastatic). Although NCCN does not codify this approach, However in its discussion it acknowledges this approach: ” In surgical stage I and II endometrial cancer, other pathologic factors that
may influence the decision regarding adjuvant therapy include LVSI,
patient age, tumor volume, depth of invasion, and lower uterine segment
or cervical glandular involvement”.
Findings/Rationale:
Nero C, Ciccarone F, Pietragalla A, Duranti S, Daniele G, Scambia G, Lorusso D. Adjuvant Treatment Recommendations in Early-Stage Endometrial Cancer: What Changes With the Introduction of The Integrated Molecular-Based Risk Assessment. Front Oncol. 2021 Sep 1;11:612450. doi: 10.3389/fonc.2021.612450. PMID: 34540651; PMCID: PMC8442623.
NCCN Uterine Cannr MS-15, 2026