How Should Inoperable Endometrial Cancer be Treated?

At the 2026 American College of Radiation Oncology (ACRO) Summit, the management of inoperable endometrial cancer stood out as a topic of growing relevance. Dominique Rash, MD, a radiation oncologist and associate professor of Radiation Medicine and Applied Sciences at University of California San Diego, discussed how clinicians define inoperability in endometrial cancer and emphasized the importance of patient-centered outcomes when treating this population. Following her presentation, CancerNetwork® spoke with Rash to further explore these themes and their implications for everyday practice.

As she stated, inoperable endometrial cancer can be broken down into 2 categories. The first is medically inoperable disease, which cannot be operated upon because there are too many complications surrounding it. These complications include other medical comorbidities or higher body mass index (BMI). The second category is disease that is too advanced, meaning it extends too far to the cervix or another part of the vagina that cannot be resected.

Beyond disease control, Rash highlighted the importance of tracking patient-centered outcomes, particularly quality of life, when treating inoperable endometrial cancer. As these patients often have competing health needs and may live for many years after treatment, some priorities include urinary toxicity and sexual function.

Rash also pointed to emerging data suggesting that treatment outcomes for medically inoperable endometrial cancer are improving. As radiation techniques, image guidance, and supportive care continue to evolve, there is a growing opportunity to not only achieve better tumor control but also preserve quality of life.

Transcript:

How do you define “inoperable” endometrial cancer?

There are a couple of ways to identify patients as inoperable. There is medically inoperable, where the surgeon has assessed that the patient is not a good candidate for surgery based on medical reasons such as other medical comorbidities, the most common of which are cardiovascular and pulmonary disease, or maybe something like higher BMI, which can make the minimally invasive laparoscopic procedures much more technically challenging. That contrasts with patients who are inoperable because their disease is too advanced. For example, if you have a uterine cancer that’s extended to the cervix, involving the parametria, or involving a portion of the vagina that cannot be resected, those patients will also be considered inoperable.

What patient-centered outcomes, like quality of life, are important to be tracked when treating this disease?

You hit the nail on the head: quality of life. With our patients who are treated with combined external beam [radiotherapy] and brachytherapy, we really want to focus on what the urinary toxicity associated with treatment is [and] the [gastrointestinal] toxicity. Then, sexual health is another big one. As you add brachytherapy to external beam [radiotherapy], there is a slightly higher risk of having a detrimental impact on the patient’s sexual function in the long term. Getting patients referred early for physical therapy or other potential interventions to help improve their quality of life is key, especially as we’re starting to see in the more recently published papers that treatment outcomes are getting a little bit better for these patients who have a medically inoperable uterus.