Table 3

ECS treatment after surgery and in advanced, metastatic, and recurrent disease

Risk groupTherapy
LowI–II POLE-mutatedFU
IntermediateStage IA without myometrial invasion (regardless of molecular status)
  • CHT (substantial LVSI, high-grade carcinoma) ± RT (sarcoma dominance)

  • FU (< 60 years)

HighStage I–IVA with myometrial invasion and RT=0 (regardless of molecular status)
  • CRT±BRT (→ CHT)

  • CHT → EBRT±BRT (→ CHT)

  • CHT alone (stage IIIA without sarcoma dominance)

Unresectable, advanced, or metastatic disease
  • Stage III–IVA with RT>0

  • Stage IVB

  • CHT+RT (concurrent or sequential)

  • NACT → surgery

  • CHT alone

  • Clinical trials

RecurrenceLocoregional or oligometastatic
  • CHT

  • Immumotherapy (with or without TKI) in patients who had prior CHT

  • RT-naïve: surgery → CHT and/or EBRT±BRT

  • Prior BRT: surgery → CHT and/or EBRT

  • Prior EBRT: surgery → CHT

  • Clinical trials

  • BRT, brachytherapy (vaginal cuff); CRT, chemoradiation (concurrent); CHT, chemotherapy; ECS, endometrial carcinosarcoma; EBRT, external beam radiotherapy; FU, follow-up; LVSI, lymphovascular space invasion; NACT, neoadjuvant chemotherapy; POLE, DNA polymerase epsilon, catalytic subunit gene; RT, radiotherapy; TKI, tyrosine kinase inhibitor.