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The treatment of endometrial cancer often involves surgery, followed by radiation therapy. Now, Dutch researchers report that radiation therapy may not be necessary for many women with stage I disease.

Cancer of the endometrium is characterized by the presence of cancer cells in the lining of the uterus, or womb. Treatment options depend on many factors, including the type, grade (how quickly the disease is likely to spread), and stage (extent of disease at diagnosis) of disease. Stage I disease consists of cancer that is confined to the body of the uterus. Stage I disease is further categorized according to stage IA disease (limited to the lining of the uterus), stage IB disease (involves up to one half of the muscle of the wall of the uterus), and stage IC disease (involves more than one half of the muscle of the wall of the uterus). The treatment for stage I endometrial cancer is surgery to remove the uterus (called total abdominal hysterectomy) as well as the ovaries and fallopian tubes (called bilateral salpingo-oophorectomy). Some women may also receive radiation therapy after the surgery to help kill any remaining cancer cells and prevent a recurrence (return of cancer) later. According to statistical data, 80 to 90% of women with stage I endometrial cancer who undergo surgery and postsurgical radiation therapy are alive 5 years after therapy. However, the role of the radiation therapy remains unclear and under study.

Researchers in the Netherlands assigned 714 women with stage I endometrial cancer to receive either A) surgery alone or B) surgery followed by radiation therapy. Many of the women had high-grade (more aggressive) cancer and/or had cancer cells present deep in the muscle wall of the uterus. The women received follow-ups for an average of 52 months. The results showed that 81% of women who received surgery plus radiation therapy were alive, compared with 85% of those who underwent surgery alone. The recurrence rates were 4% in those who had radiation therapy and 14% in those who had surgery alone. However, survival after a recurrence was significantly better in the group who had surgery alone. There were also significantly more complications in those who received the radiation therapy. The percent of patients who died from the endometrial cancer was 9% of those who received radiation therapy, compared with 6% of those who had surgery alone.

These researchers noted that, although postsurgical radiation therapy results in a reduced number of recurrences, the survival after recurrences is better in those who had surgery alone. Therefore, radiation therapy after surgery for stage I endometrial cancer does not produce any benefit in survival over the use of surgery alone. They concluded that postsurgical radiation therapy should not be given to women with stage I endometrial cancer who are younger than 60 years, and/or have grade 2 or superficial disease. However, frequent examinations are needed in patients who do not receive radiation therapy to detect and treat any recurrences early. Persons who have endometrial cancer may wish to talk with their doctor about the risks and benefits of participating in a clinical trial (research study) in which promising new therapies are being studied.

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(The Lancet, Vol 355, No 9213, pp 1404-1411, 2000).