Optimizing the management of stage II endometrial cancer: the role of radical hysterectomy and radiation

Am J Obstet Gynecol. 2009 Apr;200(4):419.e1-7. doi: 10.1016/j.ajog.2008.11.003. Epub 2009 Jan 10.


Objective: The optimal management of stage II endometrial cancer remains uncertain. We examined the role of radical hysterectomy and adjuvant radiotherapy for stage II endometrial cancer.

Study design: The Surveillance, Epidemiology, and End Results database was used to identify 1577 women with stage II endometrioid type endometrial adenocarcinoma who underwent surgical staging.

Results: The cohort included 1198 women who underwent simple hysterectomy (76%) and 379 who underwent radical hysterectomy (24%). Radical hysterectomy had no effect on survival (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.61-1.23). Patients who did not receive radiation were 48% (HR, 1.48; 95% CI, 1.14-1.93) more likely to die than those who underwent adjuvant radiotherapy. The survival benefit from radiation was most pronounced in women who underwent radical hysterectomy.

Conclusion: Adjuvant radiation improves survival. Although the routine performance of radical hysterectomy does not appear to be justified, patients with high-risk stage II tumors appear to benefit from combination therapy with radical hysterectomy and radiotherapy.

MeSH terms

  • Adult
  • Aged
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / radiotherapy*
  • Endometrial Neoplasms / surgery*
  • Female
  • Humans
  • Hysterectomy*
  • Middle Aged
  • Neoplasm Staging
  • Radiotherapy, Adjuvant
  • Uterine Neoplasms / pathology
  • Uterine Neoplasms / radiotherapy*
  • Uterine Neoplasms / surgery*