Systemic therapy for endometrial cancer: A new standard?
Mansoor R. Mirza, MD

A 61-year-old woman presents to her gynecologist and reports unprovoked postmenopausal bleeding. An endometrial biopsy confirms a FIGO grade 3 endometrial adenocarcinoma.  

  • Surgery with full surgical staging: TAH, BSO, pelvic, and paraaortic node dissection, pelvic washings for cytology
  • Pathology: Grade 3 endometrial adenocarcinoma with about 50% of myometrial invasion, present lymphovascular invasion and positive 2 of 20 pelvic nodes, all paraaortic nodes are uninvolved. Staining for estrogen and progesterone receptors is weakly positive (20% to 30%).
  • History: Hypertension well controlled with ACE inhibitor, obesity (88 kg), and urinary stress incontinence
  • Chest radiography and all laboratory studies are normal.
  • Preoperative ECOG performance status: 0

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Part I
For this patient with stage IIIC endometrial carcinoma, which of the following would you choose for postoperative management?

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Part II
She receives adjuvant chemotherapy with cisplatin and doxorubicin followed by pelvic radiotherapy. Twenty-two months later she has documented symptomatic pulmonary metastases. Liver and renal function test are normal. Performance status is 1. What would you recommend now?

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