A 58-year-old postmenopausal woman presents with abnormal uterine bleeding. Endometrial biopsy confirms endometrial adenocarcinoma, Grade 2. MRI shows tumor confined to the inner half of the myometrium with no cervical involvement. All of the following are appropriate components of her management EXCEPT:

## Risk Stratification in Early-Stage Endometrial Cancer **Key Point:** Adjuvant therapy decisions in endometrial cancer depend on histological grade, myometrial invasion depth, and FIGO stage. Grade 2 tumors with inner-half myometrial invasion (Stage IB) are classified as **intermediate-risk disease**. ### Management of Intermediate-Risk Endometrial Cancer For Stage IB, Grade 2 endometrial adenocarcinoma: | Component | Indication | Rationale | | --- | --- | --- | | **TAH-BSO** | Standard | Definitive surgical staging and treatment | | **Lymph node dissection** | Recommended | Accurate staging; improves survival in intermediate-risk disease | | **EBRT** | Standard adjuvant | Reduces locoregional recurrence in intermediate-risk disease (PORTEC-1 trial) | | **Chemotherapy** | NOT standard | Reserved for high-risk disease (Grade 3, deep invasion, serous/clear cell, advanced stage) | **High-Yield:** The PORTEC-1 trial (2000) established that intermediate-risk endometrial cancer benefits from **pelvic radiotherapy alone**. Chemotherapy is reserved for **high-risk** disease (PORTEC-3 trial, 2015) — Grade 3 tumors, serous/clear cell histology, or advanced stage. ### Why Adjuvant Chemotherapy Is NOT Indicated Here This patient has: - Grade 2 histology (not Grade 3) - Stage IB disease (inner-half myometrial invasion, no cervical/extrauterine spread) - No high-risk histological subtypes **Clinical Pearl:** Chemotherapy ± radiotherapy is reserved for **high-risk** disease. In intermediate-risk disease, **EBRT alone** is the standard adjuvant approach, as demonstrated by PORTEC-1. **Warning:** Do not confuse intermediate-risk (EBRT) with high-risk (chemotherapy ± EBRT) endometrial cancer. Grade 2 with inner-half myometrial invasion is intermediate-risk, not high-risk.