Recommendations for the treatment of endometrial cancer in settings with limited resources: Report from the International Gynecological Cancer Society consensus meeting

Fernando Maluf^1*Francinne T. Tostes^1*Henrique Alkalay Helber¹Bruno Roberto Braga Azevedo²Ligia Casao Arteaga Maluf¹Graziela Zibetti Dal Molin³Juliana Karassawa Helito¹Renato Moretti-Marques¹David Isla Ortiz⁴David Cantu⁴Agnaldo Lopes Silva Filho⁵ANGELICA NOGUEIRA-RODRIGUES⁵Reitan Ribeiro⁶Georgia Fontes Cintra⁷Gustavo Guitmann⁸Andreia Cristina de Melo⁸Eduardo Paulino⁸Glauco Baiocchi Neto⁹LEANDRO RESENDE¹⁰Michelle Samora¹¹Diocesio Alves Pinto de Andrade¹²Julio Lau de La Vega¹³Florencia Noll¹⁴Juliana Rodriguez¹⁵Fabio Fin¹⁶Andre Lopes⁹Miguel Enrique Matute Correa¹⁷Joseph S. Ng¹⁸Daniel Sanabria¹⁹Gabriel Rendon²⁰Fernando Heredia²¹Ana Paula Galerani Lopes²²Myriam Beatriz Perrota Mussi²³Marcin Bobinski²⁴Milagros Perez Quintanilla²⁵Jimena Meymar²⁶David Atallah²⁷Audrey Tsunoda^28*

• ¹Albert Einstein Israelite Hospital, São Paulo, Brazil
• ²Oncoclínicas, Curitiba, Brazil
• ³Beneficencia Portuguesa de Sao Paulo, São Paulo, Brazil
• ⁴National Institute of Cancerology mexico, Mexico, Mexico
• ⁵Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
• ⁶McGill University, Montreal, Canada
• ⁷Hospital Sao Camilo Pompeia, São Paulo, Brazil
• ⁸Brazilian National Cancer Institute, Rio de Janeiro, Brazil
• ⁹A C Camargo Cancer Center, São Paulo, Brazil
• ¹⁰Department of Surgical Oncology, Oncoclínicas, Distrito Federal, Brazil
• ¹¹Universidade Federal de Sao Paulo, São Paulo, Brazil
• ¹²InORP Group Oncoclínicas, Ribeirão Preto, Brazil
• ¹³GYNECARE Women's Health Clinic, Guatemala, Guatemala
• ¹⁴Sanatorio Allende Cerro, cordoba, Mexico
• ¹⁵National Cancer Institute, Colombia, Colombia
• ¹⁶Centro de Oncologia do Paraná, parana, Brazil
• ¹⁷ONCOPREVEE, PERU, Peru
• ¹⁸National University Cancer Institute, Singapore, Singapore
• ¹⁹Hospital de San Jose Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
• ²⁰Instituto de Cancerología, Colombia, Colombia
• ²¹Oncología Ginecológica en el Instituto Clínico de la Fundación, Providencia, Chile
• ²²Sultan Qaboos University Hospital, Seeb, Oman
• ²³Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
• ²⁴Uniwersytet Medyczny w Lublinie, Lublin, Poland
• ²⁵Medical Center ABC, Mexico CIty, Mexico, Mexico
• ²⁶Kenes International Organizers of Congresses SA, Geneva, Switzerland
• ²⁷Hotel-Dieu de France, Beirut, Lebanon
• ²⁸Department of Surgical Oncology, Oncoclinicas, Curitiba, Brazil

Abstract Introduction: Given the high disparities present in cancer care worldwide and even more challenging infrastructure and access for low-and middle-income countries, adhering precisely to international guidelines has become a challenging and complex task. Recommendations from an independent multidisciplinary panel of experts from 13 countries, including medical oncologists, pathologists, surgeons, and radiation oncologists, who met during IGCS to address some of these challenges. Methods: The panel met in New York City in September of 2022 during the Interna)onal Gynecological Cancer Society Congress and was composed of specialists from developing countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East. The panel addressed 103 questions and provided recommenda)ons for the management of early, locally advanced, recurrent, and/or metastatic endometrial cancer. The ques)ons were carefully developed by the group and specifically directed to, and answered by, specialists according to their respec)ve areas of expertise. Consensus was defined as at least 75% of the vo)ng members selec)ng a particular recommendation, whereas a majority vote was considered when one option garnered between 50.0% and 74.9% of votes. Resource limitation was defined as any issues limiting access to qualified surgeons, contemporary imaging or radiation-oncology techniques, antineoplas)c drugs, or funding for providing modern medical care. Results: Eighteen of the 109 (16.5%) ques)ons presented to the panel reached consensus, whereas a majority vote was reached for 43 (39.4%) additional questions. The recommendations for the remaining ques)ons were considerably heterogeneous and were considered experts opinion only. Conclusion: Establishing guidelines with recommenda)ons in areas with resource limitations may help healthcare providers and improve patient care around the world.