15. Research questions – Endometrial Cancer

The Guideline Group members first call attention to the consistent support of the recruiting study (ECLAT) on the therapeutic relevance of systematic lymphonodectomy, as an RCT-level reult  is achievable here.

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In reviewing the systematically searched literature, the Guideline Group members found the following questions that should be answered by high-quality studies in the future:

• Evaluation of the prognostic and predictive relevance of the new molecular classification of endometrial cancer. Since RCTs on this topic are rather unlikely, prospective cohort studies, for example in the context of registries of certified gynecologic cancer centers, seem to be a reasonable option.
• The risk of progression of complex, non-atypical endometrial hyperplasia should be recorded more precisely (registries).
• The prognostic and predictive relevance (response, progression, recurrence) of molecular classification for fertility-preserving therapy of women with atypical endometrial hyperplasia and early endometrial cancer should be evaluated retrospectively (evaluation of existing collectives) and prospectively (registry).
• The prognostic, predictive and therapeutic relevance of sentinel node biopsy should ideally be evaluated by RCTs. However, these seem rather unrealistic. Therefore, high-quality prospective registry studies (see above) should be aimed for.
• Evaluation of the oncological safety of minimally invasive surgical methods (laparoscopy, robotic) at least by high-quality prospective registry studies.
• Evaluation of the role of surgical tumor reduction, palliative hysterectomy and prior neoadjuvant chemotherapy in advanced endometrial cancer (registry).
• Evaluation of the optimal sequence of adjuvant (chemo)radiotherapy and adjuvant chemotherapy.
• Evaluation of combination chemo- plus percutaneous radiotherapy versus chemo- plus vaginal brachytherapy.
• Evaluation of risk-adapted follow-up concepts.
• Evaluation of new drug therapy concepts (e.g. trastuzumab, immune checkpoint inhibitors) in RCTs.
• Evaluation of the detection rate of germline mutations of MMR genes as a consequence of the systematic implementation of molecular classification of endometrial carcinomas.
• Evaluation of the value of preventive hysterectomies ± adnexal extirpations in women with Lynch syndrome.
• Evaluation of palliative care (APV [outpatient palliative care] and SPV [specialized palliative care]).