Table 1

Risk groups of endometrial cancer and current treatment recommendations

Risk groupESMO-ESGO-ESTRO consensus1Common treatment recommendations
Low riskStage I EEC, grade 1–2,<50% myometrial invasion, LVSI negativeNo adjuvant treatment
Low-intermediate riskStage I EEC, grade 1–2,≥50% myometrial invasion, LVSI negativeVaginal brachytherapy
(consider observation if age <60 years)
High-intermediate riskStage I EEC, grade 3,
<50% myometrial invasion, any LVSI
Stage I EEC, grade 1–2,
LVSI unequivocally positive, any myometrial invasion
Vaginal brachytherapy
Consider pelvic external beam radiotherapy if LVSI is unequivocally positive, especially if no lymph node dissection or sentinel node has been performed.
High riskStage I EEC, grade 3,
≥50% myometrial invasion, any LVSI
External beam radiotherapy
Consider vaginal brachytherapy if no LVSI
Stage II EEC
Vaginal brachytherapy if grade 1–2 and LVSI negative
Pelvic radiotherapy if :
  • Stage II, grade 3

  • LVSI unequivocally positive

  • Stage III

Stage III: combined adjuvant radiotherapy and chemotherapy (PORTEC-3 schedule or sequential)
NEEC stage I–III (serous, clear cell or undifferentiated cancers; carcinosarcoma)Vaginal brachytherapy if serous/clear cell, stage IA after full surgical staging, LVSI negative
Stage IB–III: combined adjuvant pelvic radiotherapy and chemotherapy
  • EEC, endometrioid endometrial cancer; ESGO, European Society of Gynecological Oncology; ESMO, European Society for Medical Oncology; ESTRO, European Society; LVSI, lymph-vascular space invasion; NEEC, non-endometrioid endometrial cancer; PORTEC, post operative radiation therapy endometrial cancer.