Avoidance of adjuvant radiotherapy in inter mediate-risk endometrial carcinoma

Endometrial carcinoma is one of the most common gynecological malignancies, classified into various risk categories based on histopathological parameters. Despite not demonstrating an overall survival benefit, the standard treatment approach in patients with intermediate-risk endometrial carcinoma has historically included adjuvant radiotherapy. However, this intervention may not be requisite for all patients within this classification. A Cochrane meta-analysis, including the PORTEC-2 and GOG-99 studies, indicate that the addition of radiotherapy may not yield substantial survival benefits, while potentially compromising quality-of-life due to treatment-related morbidities. International guidelines generally recommend adjuvant radiotherapy, but list observation as a possible post-surgical strategy. This review aims to assess the current literature on adjuvant radiotherapy in intermediate-risk endometrial carcinoma. A multidisciplinary approach that incorporates shared decision-making, quality-of-life assessments, and ongoing research into the molecular classification of tumors can lead to more personalized treatment paradigms. Ultimately, this article advocates for a more selective use of adjuvant radiotherapy based on individual patient assessments and evolving evidence in women diagnosed with intermediate-risk endometrial carcinoma.