Bridging adjuvant treatment gaps: low and intermediate risk endometrial carcinoma patients care in Salah Azaiez Institute in Tunisia
Abstract Background The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatme...
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| Published in: | The oncologist (Dayton, Ohio) Vol. 30; no. 9 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Oxford University Press
01.09.2025
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| ISSN: | 1083-7159, 1549-490X, 1549-490X |
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| Abstract | Abstract
Background
The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatment are observed. This study explores how adherence to international recommendations affects clinical outcomes.
Methods
We performed a retrospective analytic study including 180 women with stage I–II low-, low-intermediate-, and high-intermediate-risk EC treated at SAI between 2015 and 2020, with at least 3 years of follow-up. Ethical approval and patient consent were obtained; for telephone interviews, verbal consent was secured. We selected 60 women per risk group from a larger pool to ensure comparability. Eleven histopathologic slides exhibiting lymphovascular space invasion (LVSI) were reviewed independently by 2 experienced pathologists to distinguish focal from extensive LVSI; no slides without LVSI were reexamined. Risk stratification followed the 2020 ESGO–ESTRO–ESP guidelines, and adjuvant treatments were assessed according to the 2021 ESGO–ESTRO recommendations. Pelvic lymphadenectomy was the standard nodal assessment; sentinel lymph node (SLN) mapping was not available during the study period.
Results
Median age was 60 years (range 35–69). After histopathologic review, 51.1% of tumors were grade 2, 54.5% had under 50% myometrial invasion, 8.3% had extensive LVSI, and 3.9% had focal LVSI. Forty-seven per cent of patients received guideline-concordant therapy, 47% were over-treated, and 6% were under-treated. Over-treated women had a 7.9-fold higher risk of death and a 6.6-fold higher risk of recurrence than appropriately treated women. Under-treatment was not a significant prognostic factor. Overtreatment and guideline-concordant therapy were both associated with higher rates of gastrointestinal, genitourinary, and sexual toxicities.
Conclusion
Limited access to molecular profiling constrains personalized care in Tunisia. Strict adherence to current guidelines is essential to avoid unnecessary toxicity, and the integration of molecular classification and SLN mapping should be prioritized. |
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| AbstractList | The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatment are observed. This study explores how adherence to international recommendations affects clinical outcomes.BACKGROUNDThe management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatment are observed. This study explores how adherence to international recommendations affects clinical outcomes.We performed a retrospective analytic study including 180 women with stage I-II low-, low-intermediate- and high-intermediate-risk EC treated at SAI between 2015 and 2020, with at least three years of follow-up. Ethical approval and patient consent were obtained; for telephone interviews, verbal consent was secured. We selected sixty women per risk group from a larger pool to ensure comparability. Eleven histopathologic slides exhibiting lymphovascular space invasion (LVSI) were reviewed independently by two experienced pathologists to distinguish focal from extensive LVSI; no slides without LVSI were reexamined. Risk stratification followed the 2020 ESGO-ESTRO-ESP guidelines and adjuvant treatments were assessed according to the 2021 ESGO-ESTRO recommendations. Pelvic lymphadenectomy was the standard nodal assessment; sentinel lymph node mapping was not available during the study period.METHODSWe performed a retrospective analytic study including 180 women with stage I-II low-, low-intermediate- and high-intermediate-risk EC treated at SAI between 2015 and 2020, with at least three years of follow-up. Ethical approval and patient consent were obtained; for telephone interviews, verbal consent was secured. We selected sixty women per risk group from a larger pool to ensure comparability. Eleven histopathologic slides exhibiting lymphovascular space invasion (LVSI) were reviewed independently by two experienced pathologists to distinguish focal from extensive LVSI; no slides without LVSI were reexamined. Risk stratification followed the 2020 ESGO-ESTRO-ESP guidelines and adjuvant treatments were assessed according to the 2021 ESGO-ESTRO recommendations. Pelvic lymphadenectomy was the standard nodal assessment; sentinel lymph node mapping was not available during the study period.Median age was 60 years (range 35-69). After histopathologic review, 51.1% of tumors were grade 2, 54.5% had under 50% myometrial invasion, 8.3% had extensive LVSI and 3.9% had focal LVSI. Forty-seven per cent of patients received guideline-concordant therapy, 47% were over-treated and 6% were under-treated. Over-treated women had a 7.9-fold higher risk of death and a 6.6-fold higher risk of recurrence than appropriately treated women. Under-treatment was not a significant prognostic factor. Overtreatment and guideline-concordant therapy were both associated with higher rates of gastrointestinal, genitourinary and sexual toxicities.RESULTSMedian age was 60 years (range 35-69). After histopathologic review, 51.1% of tumors were grade 2, 54.5% had under 50% myometrial invasion, 8.3% had extensive LVSI and 3.9% had focal LVSI. Forty-seven per cent of patients received guideline-concordant therapy, 47% were over-treated and 6% were under-treated. Over-treated women had a 7.9-fold higher risk of death and a 6.6-fold higher risk of recurrence than appropriately treated women. Under-treatment was not a significant prognostic factor. Overtreatment and guideline-concordant therapy were both associated with higher rates of gastrointestinal, genitourinary and sexual toxicities.Limited access to molecular profiling constrains personalized care in Tunisia. Strict adherence to current guidelines is essential to avoid unnecessary toxicity, and the integration of molecular classification and sentinel lymph node mapping should be prioritised.CONCLUSIONLimited access to molecular profiling constrains personalized care in Tunisia. Strict adherence to current guidelines is essential to avoid unnecessary toxicity, and the integration of molecular classification and sentinel lymph node mapping should be prioritised. Abstract Background The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatment are observed. This study explores how adherence to international recommendations affects clinical outcomes. Methods We performed a retrospective analytic study including 180 women with stage I–II low-, low-intermediate-, and high-intermediate-risk EC treated at SAI between 2015 and 2020, with at least 3 years of follow-up. Ethical approval and patient consent were obtained; for telephone interviews, verbal consent was secured. We selected 60 women per risk group from a larger pool to ensure comparability. Eleven histopathologic slides exhibiting lymphovascular space invasion (LVSI) were reviewed independently by 2 experienced pathologists to distinguish focal from extensive LVSI; no slides without LVSI were reexamined. Risk stratification followed the 2020 ESGO–ESTRO–ESP guidelines, and adjuvant treatments were assessed according to the 2021 ESGO–ESTRO recommendations. Pelvic lymphadenectomy was the standard nodal assessment; sentinel lymph node (SLN) mapping was not available during the study period. Results Median age was 60 years (range 35–69). After histopathologic review, 51.1% of tumors were grade 2, 54.5% had under 50% myometrial invasion, 8.3% had extensive LVSI, and 3.9% had focal LVSI. Forty-seven per cent of patients received guideline-concordant therapy, 47% were over-treated, and 6% were under-treated. Over-treated women had a 7.9-fold higher risk of death and a 6.6-fold higher risk of recurrence than appropriately treated women. Under-treatment was not a significant prognostic factor. Overtreatment and guideline-concordant therapy were both associated with higher rates of gastrointestinal, genitourinary, and sexual toxicities. Conclusion Limited access to molecular profiling constrains personalized care in Tunisia. Strict adherence to current guidelines is essential to avoid unnecessary toxicity, and the integration of molecular classification and SLN mapping should be prioritized. The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatment are observed. This study explores how adherence to international recommendations affects clinical outcomes. We performed a retrospective analytic study including 180 women with stage I-II low-, low-intermediate-, and high-intermediate-risk EC treated at SAI between 2015 and 2020, with at least 3 years of follow-up. Ethical approval and patient consent were obtained; for telephone interviews, verbal consent was secured. We selected 60 women per risk group from a larger pool to ensure comparability. Eleven histopathologic slides exhibiting lymphovascular space invasion (LVSI) were reviewed independently by 2 experienced pathologists to distinguish focal from extensive LVSI; no slides without LVSI were reexamined. Risk stratification followed the 2020 ESGO-ESTRO-ESP guidelines, and adjuvant treatments were assessed according to the 2021 ESGO-ESTRO recommendations. Pelvic lymphadenectomy was the standard nodal assessment; sentinel lymph node (SLN) mapping was not available during the study period. Median age was 60 years (range 35-69). After histopathologic review, 51.1% of tumors were grade 2, 54.5% had under 50% myometrial invasion, 8.3% had extensive LVSI, and 3.9% had focal LVSI. Forty-seven per cent of patients received guideline-concordant therapy, 47% were over-treated, and 6% were under-treated. Over-treated women had a 7.9-fold higher risk of death and a 6.6-fold higher risk of recurrence than appropriately treated women. Under-treatment was not a significant prognostic factor. Overtreatment and guideline-concordant therapy were both associated with higher rates of gastrointestinal, genitourinary, and sexual toxicities. Limited access to molecular profiling constrains personalized care in Tunisia. Strict adherence to current guidelines is essential to avoid unnecessary toxicity, and the integration of molecular classification and SLN mapping should be prioritized. Background: The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and the advent of the molecular era. We lack access to molecular profiling; consequently, both undertreatment and overtreatment are observed. This study explores how adherence to international recommendations affects clinical outcomes. Methods: We performed a retrospective analytic study including 180 women with stage I-II low-, low-intermediate-, and high-intermediate-risk EC treated at SAI between 2015 and 2020, with at least 3 years of follow-up. Ethical approval and patient consent were obtained; for telephone interviews, verbal consent was secured. We selected 60 women per risk group from a larger pool to ensure comparability. Eleven histopathologic slides exhibiting lymphovascular space invasion (LVSI) were reviewed independently by 2 experienced pathologists to distinguish focal from extensive LVSI; no slides without LVSI were reexamined. Risk stratification followed the 2020 ESGO-ESTRO-ESP guidelines, and adjuvant treatments were assessed according to the 2021 ESGO-ESTRO recommendations. Pelvic lymphadenectomy was the standard nodal assessment; sentinel lymph node (SLN) mapping was not available during the study period. Results: Median age was 60 years (range 35-69). After histopathologic review, 51.1% of tumors were grade 2, 54.5% had under 50% myometrial invasion, 8.3% had extensive LVSI, and 3.9% had focal LVSI. Forty-seven per cent of patients received guideline-concordant therapy, 47% were over-treated, and 6% were under-treated. Over-treated women had a 7.9-fold higher risk of death and a 6.6-fold higher risk of recurrence than appropriately treated women. Under-treatment was not a significant prognostic factor. Overtreatment and guideline-concordant therapy were both associated with higher rates of gastrointestinal, genitourinary, and sexual toxicities. Conclusion: Limited access to molecular profiling constrains personalized care in Tunisia. Strict adherence to current guidelines is essential to avoid unnecessary toxicity, and the integration of molecular classification and SLN mapping should be prioritized. Key words: endometrial carcinoma; low risk; intermediate risk; guidelines adherence; adjuvant treatment; molecular era; low-resource settings |
| Audience | Professional Academic |
| Author | Zarraa, Semia Yousfi, Ameni Sahraoui, Ghada Yahiaoui, Safia Nasr, Chiraz Ben Zid, Khadija Boudhina, Emna Ghorbel, Asma Abidi, Rim Mousli, Alia |
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| Cites_doi | 10.1002/(SICI)1097-0215(19990702)82:1<38::AID-IJC8>3.0.CO;2-Q 10.1016/j.gofs.2021.03.005 10.1097/PGP.0000000000000806 10.3802/jgo.2015.26.1.32 10.1111/j.1471-0528.2011.03201.x 10.1016/j.ygyno.2022.02.001 10.1007/s00125-007-0681-5 10.1093/jnci/djn397 10.1038/sj.bjc.6603933 10.1038/bjc.2014.407 10.1016/S1470-2045(13)70591-6 10.1006/gyno.1995.1005 10.4274/tjod.galenos.2022.47835 10.1016/S0140-6736(15)00130-0 10.1016/j.ejca.2015.05.015 10.1007/s00432-013-1504-3 10.1016/j.radonc.2020.11.018 10.1136/ijgc-2019-000317 10.1016/S1470-2045(10)70218-7 10.1016/j.brachy.2011.08.005 10.4103/jcrt.jcrt_1173_21 10.1002/cam4.4423 10.1016/S1470-2045(10)70145-5 10.6004/jnccn.2023.0006 10.1097/CCO.0000000000000874 10.1111/IGC.0b013e3181a6c9df 10.1016/j.ygyno.2022.07.012 10.1155/2018/7924153 10.1055/a-1545-4279 10.1093/annonc/mdv484 10.1038/bjc.2014.237 10.5858/arpa.2022-0280-RA 10.1016/j.jmig.2020.12.025 |
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| Keywords | low risk intermediate risk molecular era endometrial carcinoma guidelines adherence adjuvant treatment low-resource settings |
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The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international... The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international recommendations and... Background: The management of low- and intermediate-risk endometrial carcinoma (EC) at the Salah Azaiez Institute (SAI) has evolved with international... |
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| SubjectTerms | Adjuvant treatment Adult Aged Cancer Care and treatment Chemotherapy, Adjuvant - methods Endometrial cancer Endometrial Neoplasms - pathology Endometrial Neoplasms - therapy Female Humans Medically underserved areas Middle Aged Oncology, Experimental Practice guidelines (Medicine) Retrospective Studies Social aspects Tunisia - epidemiology |
| Title | Bridging adjuvant treatment gaps: low and intermediate risk endometrial carcinoma patients care in Salah Azaiez Institute in Tunisia |
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