Editorials

Management of stage 1 endometrial carcinoma

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7286.568 (Published 10 March 2001) Cite this as: BMJ 2001;322:568

Postoperative radiotherapy is not justified in women with medium risk disease

  1. Matthé P M Burger (m.p.m.burger@amc.uva.nl), professor of gynaecology
  1. Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, and the Netherlands Cancer Institute, Netherlands

    Endometrial adenocarcinoma mainly affects postmenopausal women. The mainstay of treatment is hysterectomy with bilateral salpingo-oophorectomy. Most women are diagnosed with stage1 disease, where the tumour is limited to the body of the uterus. Within this stage the differentiation grade and depth of myometrial invasion are among the most important predictors for the presence of regional (pelvic and para-aortic) lymph node metastases and recurrence. 1 2

    In the absence of mature results from randomised trials, debate continues on the merits of pelvic and para-aortic lymphadenectomy and postoperative radiotherapy.

    The practice of lymphadenectomy varies considerably.3 Several opinion leaders, mainly from the United States, state that every women with endometrial carcinoma should undergo complete lymphadenectomy. Some gynaecologists who as a rule do complete lymphadenectomies restrict themselves to selective node sampling in certain subgroups of women. One subgroup comprises patients who are less suited to complete lymphadenectomy because of age, obesity, or frailty from complicating medical problems—and up to 70% of patients with clinically early stage uterine cancer …

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