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Practice Guideline
. 2025 Aug;26(8):e423-e435.
doi: 10.1016/S1470-2045(25)00167-6.

ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: update 2025

Nicole Concin  1 , Xavier Matias-Guiu  2 , David Cibula  3 , Nicoletta Colombo  4 , Carien L Creutzberg  5 , Jonathan Ledermann  6 , Mansoor Raza Mirza  7 , Ignace Vergote  8 , Nadeem R Abu-Rustum  9 , Tjalling Bosse  10 , Cyrus Chargari  11 , Sophie Espenel  12 , Anna Fagotti  13 , Christina Fotopoulou  14 , Sonia Gatius  15 , Antonio González-Martin  16 , Sigurd Lax  17 , Bar Levy  18 , Domenica Lorusso  19 , Gabriella Macchia  20 , Christian Marth  21 , Philippe Morice  22 , Ana Oaknin  23 , Maria Rosaria Raspollini  24 , Richard Schwameis  25 , Jalid Sehouli  26 , Alina Sturdza  27 , Alexandra Taylor  28 , Anneke Westermann  29 , Pauline Wimberger  30 , François Planchamp  31 , Remi A Nout  32
Affiliations
Practice Guideline

ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: update 2025

Nicole Concin et al. Lancet Oncol. 2025 Aug.

Erratum in

Abstract

In 2023, based on advances in the understanding of the pathological and molecular features of endometrial carcinoma, an updated International Federation of Gynaecology and Obstetrics (FIGO) staging system was published, aiming to better define prognostic groups and identify relevant treatment subgroups by including factors reflecting tumour biology (histological subtypes, lymphovascular space invasion, and molecular classification) alongside refinements of anatomical factors (peritoneal carcinomatosis and lymph node metastasis). As part of its mission to improve the quality of care for people with gynaecological cancers, the European Society of Gynaecological Oncology (ESGO), European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) updated the ESGO-ESTRO-ESP evidence-based guidelines published in 2021 by incorporating this revised FIGO staging and the large body of new evidence addressing the management of endometrial carcinoma. The development process of these guidelines was based on a systematic literature review and critical appraisal process involving an international multidisciplinary development group consisting of 30 experts from relevant disciplines (gynaecological oncology, radiation oncology, medical oncology, and pathology). A patient representative was also included. Before publication, the guidelines were reviewed by 225 independent international practitioners in cancer care delivery and three patient representatives from Asia, Europe, North Africa, North America, the Middle East, and South America to ensure a global perspective. These guidelines comprehensively cover diagnosis, management, follow-up, and patient education. Management includes surgical and adjuvant therapy according to the stage of the disease, and metastatic and recurrent disease. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.

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Conflict of interest statement

Declaration of interests NCon reports advisory boards for AbbVie, MSD, ImmunoGen, Seagen, Akesobio, EISAI, GSK, AstraZeneca, Mersana, Seattle Genetics, eTheRNA immunotherapies NV, Kartos, and Daiichi Sankyo, and grants for traveling from Amgen, Genmab, GSK, Roche, and Medtronic. XM-G reports advisory boards for AstraZeneca, Eli Lilly, Amgen, GSK, Janssen, Illumina, MSD, Daiichi Sankyo, and AbbVie, and grants for traveling from Roche, Ferrer, Novartis, Menarini, Biocartis, Agilent-Dako, Leyca, Sysmex, MSD, AstraZeneca, BMS, GSK, Clovis, and Eisai. DC reports advisory boards for AstraZeneca, GSK, Karyopharm Therapeutics, MSD, Novocure, Roche, and AbbVie. NCol reports advisory boards for AstraZeneca, Clovis Oncology, Eisai, GSK, ImmunoGen, Mersana, MSD/Merck, Nuvation Bio, Onxerna, Pfizer, PharmaMar, Pieris and Roche, Novocure, Biontech, Gilead, and Genmab, and grants for traveling from AstraZeneca, GSK, MSD, and Eisai. JL reports advisory boards for AstraZeneca, GSK, Merck/MSD, and Eisai. MRM reports advisory boards for AstraZeneca, BioNTech, Daiichi Sankyo, Eisai, GSK, Immunogen/AbbVie, Incyte, Karyopharm Therapeutics, Merck, Regeneron, and Zailab; research grant (institutional) from Apexigen, AstraZeneca, GSK, and Ultimovacs; invited speaker activities for AstraZeneca and GSK; financial interests from Karyopharm Therapeutics (member of board of Directors and stocks/shares) and Deciphera (trial chair, institutional); and non-financial interests (advisory role for Ultimovacs and Prix Galien Foundation Member, Member of Prix Galien Awar). IV reports consulting advice for Akesobio, BMS, Deciphera Pharmaceuticals, Eisai, Elevar Therapeutics, F Hoffmann-La Roche, Genmab, GSK, ITM, Jazzpharma, Karyopharm Therapeutics, MSD, Novocure, Oncoinvent, Sanofi, Regeneron, Seagen, and Zentalis, and consulting data monitoring committees for Agenus, AstraZeneca, Corcept, Daiichi Sankyo, F Hoffmann-La Roche, Immunogen, Kronos Bio, Mersana, Novartis, OncXena, and Verastem Oncology. NRA-R reports a support in part by a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30 CA008748), and research funding from GRAIL paid to their institution. CC reports advisory boards for GSK, MSD, and Eisai. CF reports honoraria from Oncoinvent, GSK, Roche, AstraZeneca/MSD, and Medronic. AG-M reports advisory boards for Alkermes, Amgen, AstraZeneca, Clovis Oncology, Genmab, GSK, HederaDx, AbbVie/Immunogen, Incyte, Illumina, Mersana, MSD, Novartis, Novocure, Oncoinvent, PharmaMar, Regeneron, Roche, SOTIO, SUTRO, Seagen, Takeda, Tubulis, and Zailab, and grants for traveling from GSK, Roche, MSD, and AstraZeneca. SL reports honoraria for lectures from AstraZeneca, Biocartis, MSD, GSK, Daiichi Sankyo, Novartis, PharmaMar, and StemlineTherapeutics. DL reports advisory boards for AstraZeneca, Clovis Oncology, Corcept, Daiichi Sankyo, Genmab, GSK, Immunogen, MSD, Oncoinvest, Novocure, Seagen, and Sutro, and grants for traveling from AstraZeneca, Menarini, GSK, MSD, and Daiichi Sankyo. CM reports advisory boards for Roche, Novartis, MSD, PharmaMar, AstraZeneca, Pfizer, Immunogen, Daiichi Sankyo, BioNTech, Novocure, Eisai, GSK, and AbbVie, and grants for traveling from Roche, Novartis, MSD, and AstraZeneca. AO reports advisory boards for AbbVie, Agenus, AstraZeneca, Clovis Oncology, Corcept Therapeutics, Deciphera Pharmaceuticals, Daiichi Sankyo, Debiopharm, Eisai, Exelisis, F Hoffmann-La Roche, Genmab, GSK, ImmunoGen, Itheos, MSD, Mersana Therapeutics, Myriad Genetics, Novocure, OncoXerna Therapeutics, PharmaMar, Regeneron, Sattucklabs, Seagen/Pfizer, Sutro Biopharma, TORL Therapuetics, Zentalis, and Zymeworks, and grants for traveling from AstraZeneca, GSK, PharmaMar, and Roche. RS reports advisory boards for GSK and grants for traveling from MSD, GSK, and AstraZeneca. JS reports grants or contracts from Roche, MSD, GSK, Tesaro, AstraZeneca, Eisai, Merck, and Novocure; consulting fees for Merck/Pfizer, PharmaMar, Clovis Oncology, AstraZeneca, Roche, GSK, MSD, Eisai, Novocure, Oncoinvent, Intuitive Surgical, Seagen, Bayer Vital, Mundipharma, Sanofi-Aventis Deutschland, Immunogen, Tubulis, Daiichi Sankyo, BMS, Karyopharm, and Corcept Therapeutics; honoraria from GSK, PharmMar, AstraZeneca, Clovis Oncology, Bayer, Roche, Vifor Pharma, Hexal AG, Novartis, Eisai, Esteve Pharmaceuticals, Incyte Biosciences, Phytolife Nutrition, JenaPharm, Kyowa Kirin, Onconinvent, Daiichi Sankyo, Medtronic Covidien, Amgen, AbbVie, Corcept Therapeutics, Gilead Sciences, and Myriad; grants for traveling from GSK, AstraZeneca, Roche, Novocure, Immunogen, Incyte, MSD, and Eisai; participation on a data safety monitoring board or advisory boards for Immunogen, Incyte, GSK, AstraZeneca, Clovis Oncology, Novocure, BMS, MSD, Merck, Bayer, and PharmaMar; leadership of fiduciary role for ENGAGe, ESGO, ASCO, GCIG, Deutsche Stiftung Eierstockkrebs, and AGO; and medical writing for MSD. AS reports advisory boards for GROINS VIII and grants for traveling from Elekta. AT reports a grant for traveling from MSD. PW reports advisory boards from Amgen, AbbVie, AstraZeneca, MSD, GSK, Novartis, Pfizer, Roche, Clovis Oncology, TEVA, Eisai, Eli Lilly, Gilead, and Daiichi Sankyo, research funding received for her institution from Amgen, AbbVie, AstraZeneca, MSD, GSK, Novartis, Pfizer, Roche Pharma, Clovis Oncology, Eli Lilly, and honoraria from Amgen, AbbVie, AstraZeneca, MSD, GSK, Novartis, Pfizer, Roche Pharma, Clovis Oncology, TEVA, Eisai, Eli Lilly, Gilead, and Daiichi Sankyo. RAN reports grants or contracts from the Dutch Cancer Society, Dutch Research Council, Elekta, Varian, Accuracy, Sensuis, and Senewald paid to his institution; honoraria from Elekta, MSD, and GSK paid to his institution; and leadership for the Dutch Gynecological Oncology Group (chair) and the GCIG Cervical Cancer Research Network (chair). All other authors declare no competing interests.

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