title: Long-term outcomes after pelvic radiation for early-stage endometrial cancer.
abstract: OBJECTIVE
  This follow-up of a randomized study was conducted to assess the long-term effects of external beam radiation therapy (EBRT) in the adjuvant treatment of early-stage endometrial cancer.
  
  
  METHODS
  Between 1968 and 1974, 568 patients with stage I endometrial cancer were included. After primary surgery, patients were randomly assigned to either vaginal radium brachytherapy followed by EBRT (n = 288) or brachytherapy alone (n = 280). Overall survival was analyzed by using the Kaplan-Meier method. A Cox proportional hazards model was used to estimate hazard ratios (HRs) with 95% CIs. We also conducted analyses stratified by age groups.
  
  
  RESULTS
  After median 20.5 years (range, 0 to 43.4 years) of follow-up, no statistically significant difference was revealed in overall survival (P = .186) between treatment groups. However, women younger than age 60 years had significantly higher mortality rates after EBRT (HR, 1.36; 95% CI, 1.06 to 1.76) than the control group. The risk of secondary cancer increased after EBRT, especially in women younger than age 60 years (HR, 2.02; 95% CI, 1.30 to 3.15).
  
  
  CONCLUSIONS
  We observed no survival benefit of external pelvic radiation in early-stage endometrial carcinoma. In women younger than age 60 years, pelvic radiation decreased survival and increased the risk of secondary cancer. Adjuvant EBRT should be used with caution, especially in women with a long life expectancy.
authors.affiliation: Mathias Onsrud, Taran P. Hellebust, Claes G. Tropé, and Gunnar B. Kristensen, Norwegian Radium Hospital, Oslo University Hospital; Mathias Onsrud, Milada Cvancarova, Taran P. Hellebust, and Claes G. Tropé, University of Oslo, Oslo; Taran P. Hellebust, Norwegian Radiation Protection Authority, Østerås; and Kristina Lindemann, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova
authors.forename: Taran P
authors.initials: TP
authors.lastname: Hellebust
authors.forename: Claes G
authors.initials: CG
authors.lastname: Tropé
authors.forename: Gunnar B
authors.initials: GB
authors.lastname: Kristensen
authors.forename: Kristina
authors.initials: K
authors.lastname: Lindemann
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D010388:Pelvis / Q000528:radiation effects; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods*; D013995:Time