Challenging Therapeutic Paradigms: Response-adapted Multimodality Treatment in Metastatic Endometrial Carcinoma

Abstract

Metastatic endometrial carcinoma is typically approached with palliative intent, with durable remission considered uncommon. We report the case of a 63-year-old woman presenting with Stage IVB endometrial carcinoma with hepatic and skeletal metastases. Histopathology revealed high-grade endometrioid carcinoma with p53 positivity. Baseline FDG PET-CT demonstrated extensive disease involving the uterus, lymph nodes, liver, and bone. She received platinum–taxane chemotherapy with palliative radiotherapy to sites at risk of skeletal complications. Remarkably, post-treatment imaging showed complete metabolic resolution of all metastatic lesions, with only residual uptake in the uterine primary. In view of this exceptional response, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection, achieving pathological downstaging to ypT1aN0. At three years of follow-up, she remains disease-free, with no evidence of metabolic activity on PET-CT. This case challenges conventional expectations in metastatic endometrial carcinoma, particularly in the context of p53-abnormal disease, and highlights the possibility of profound chemosensitivity in select patients. It underscores the importance of response-adapted, multidisciplinary management and suggests that carefully chosen patients with advanced disease may benefit from a curative-intent approach.