Adjuvant Therapy for Stage IIB Endometrioid Ovarian Carcinoma
For stage IIB endometrioid ovarian carcinoma, adjuvant pelvic radiotherapy (with or without intravaginal radiotherapy) is recommended following extended radical hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection. 1
Standard Treatment Approach
Surgical Management
- Extended radical hysterectomy
- Bilateral salpingo-oophorectomy
- Lymph node dissection
Adjuvant Therapy Options
Primary Recommendation: Pelvic Radiotherapy
- Indicated for patients who have had an extrafascial hysterectomy or who have high-risk disease 1
- May include intravaginal radiotherapy component based on risk factors
Alternative Option: Platinum-based Chemotherapy
- While the British Journal of Cancer guidelines note that there is no definitive standard for stage IIB tumors without residual disease, platinum-based chemotherapy is considered an option alongside radiotherapy 1
- The most current regimen would be carboplatin plus paclitaxel, which has become the standard in the treatment of ovarian cancers 2
Risk Stratification for Treatment Decision
Treatment decisions should be based on additional risk factors:
High-Risk Features (indicating need for more aggressive adjuvant therapy)
- Grade 3 histology
- Deep myometrial invasion
- Lymphovascular space invasion (LVSI)
- Age ≥60 years
- Inadequate surgical staging
Treatment Algorithm
- Standard Risk Stage IIB: Pelvic radiotherapy
- High-Risk Stage IIB: Consider combined or sequential approach with both chemotherapy and radiotherapy
Evidence Considerations
The ESMO guidelines specifically state that for stage IIb endometrioid carcinoma, patients who have had an extrafascial hysterectomy or who have high-risk disease should receive adjuvant pelvic radiotherapy 1
While some evidence suggests potential benefit of combined modality treatment (chemotherapy plus radiotherapy), the optimal sequencing remains unclear - options include sequential treatment or a "sandwich" approach 3
For patients with high-risk features, the addition of chemotherapy may help address the risk of distant metastases, as radiotherapy primarily addresses locoregional control 3
Important Caveats
Intraperitoneal brachytherapy is not recommended based on level B evidence 1
The toxicity of radiotherapy is increased in patients who have undergone multiple previous operations and in those receiving pelvic boosts 1
When chemotherapy is chosen, carboplatin has equivalent efficacy to cisplatin with less non-hematological toxicity but greater hematological toxicity 1
The standard duration for chemotherapy is typically 6 courses, with no proven survival benefit for extending beyond this 1
While progestational agents are active in steroid-receptor positive tumors (mostly G1 and G2 lesions), their adjuvant administration in low-stage endometrial cancer does not increase survival and is not recommended 1