ADAPT-EM | Adjuvant Therapy Decision Support

Tumor & pathology

Molecular class (WHO 2020)

Double classifier (POLEmut + p53abn) → select POLEmut (ESGO 2021).

Anatomic extent (FIGO 2009 basis)

Anatomic only — biology entered separately; tool derives both FIGO 2009 & 2023 labels.

Grade Histology Substantial LVSI Deep myometrial invasion (≥50%) Age band ECOG performance status

Higher ECOG raises competing mortality & toxicity burden; ECOG ≥3 removes cytotoxic chemo options.

Estrogen-receptor status (NSMP) Macroscopic residual disease L1CAM overexpression

Patient preferences & goals

Set what matters most to this patient — each choice is plain-language, and the recommendation updates to match their priorities.

1 · Overall goal

Sets the overall balance between fighting the cancer and limiting side effects.

2 · How much does the patient want to AVOID each side effect?

Long-term bowel / bladder problems (from radiation) Chemotherapy effects (fatigue, numbness, hair loss, low counts) Immunotherapy side effects (thyroid, gut, skin, etc.) Treatment burden (clinic visits, time, long maintenance) 3 · General health / life expectancy

Limited life expectancy favors gentler options.

4 · Only suggest added treatment if it improves 5-yr survival by at least…

5 · Deal-breakers (rule an option out)

No IV chemotherapy Can’t do daily radiation (~5 weeks) No long maintenance therapy Preserve vaginal / sexual function

Ranked strategies by net clinical benefit

Strategy & supporting evidence	5-yr RFS	5-yr OS	ΔRFS	ΔOS	Meets goal	Gr≥3	Net QALY

How to read this

Recommendation is the best evidence-based option after applying your preferences. Immunotherapy/PARP in early stage and other emerging options are tagged Investigational; deal-breakers mark options Excluded. "Meets goal" flags whether an option clears your minimum-benefit threshold. Net benefit = quality-adjusted life-years vs observation after subtracting preference-weighted toxicity. Trial names link to PubMed.

Strategies: observation; vaginal brachytherapy; pelvic EBRT; VBT + chemotherapy (GOG-249); chemoradiation (PORTEC-3); chemotherapy (GOG-122); chemo + immunotherapy (RUBY, NRG-GY018); chemo + immunotherapy + PARP (DUO-E). Engine: molecular-anchored baseline risk × subgroup-conditional trial HRs × preference-weighted toxicity, integrated by a 3-state competing-outcomes QALY model; identical to the reference Python implementation (max difference <10−¹⁵). Not for clinical use without external validation. Created by Adrian Kohut, MD. © 2026 Adrian Kohut, MD.