Objectives: Adjuvant radiotherapy (RT) in early-stage endometrial cancer is guided by clinicopathologic risk factors, but treatment practices vary across institutions. This study aimed to describe patterns of RT use and determinants of modality selection in the pre-molecular classification era. Material and Methods: We retrospectively analysed 96 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II endometrial carcinoma treated between 2018 and 2023. Clinical and pathological parameters, including age, stage, grade, histology, lymphovascular space invasion (LVSI), and myometrial invasion (MMI), were recorded. Patients were categorised into guideline-defined risk groups, and RT modalities were classified as vaginal brachytherapy (VBT), external beam radiotherapy (EBRT), combined EBRT+VBT, or no RT. Associations between clinicopathologic factors and RT modality were assessed descriptively. Results: The median age was 59 years (range, 41–77), and most patients had endometrioid histology (93.8%). Stage distribution was IA (36.5%), IB (52.1%), and II (11.5%). Among low-risk patients, VBT was the predominant modality (73%), while in intermediate-risk patients, VBT remained most common (65%), with EBRT+VBT used in 27%. In the high-intermediate-risk group, EBRT+VBT was administered in 81%, and in high-risk patients, EBRT+VBT with or without chemotherapy was given in 67%. LVSI-positive patients were more likely to receive EBRT-containing regimens, and all stage II patients received EBRT+VBT. At a median follow-up of 36 months (range, 24–96), no recurrences or deaths were observed. Conclusion: RT decisions in this cohort were strongly risk-adapted and consistent with guideline recommendations, even in the absence of molecular profiling. Stage, LVSI, and depth of myometrial invasion were the key drivers of modality selection. These findings provide a benchmark for the future integration of genomic classifiers in adjuvant treatment planning.
Shibu et al. (2026) studied this question.