A blast from the past and foresight for the future of gynecologic oncology

This is the long-term follow-up of the Norwegian Radium Hospital randomized trial for women with early-stage endometrial cancer. Between 1968 and 1974, 568 women with clinical stage I endometrial cancer received 60 Gy of vaginal brachytherapy after hysterectomy. The women were then randomized to 40 Gy pelvic radiation therapy with a central block after 20 Gy or to no further therapy. The initial analysis, published in 1980 by Aalders et al (9), reported a reduction in pelvic recurrences in patients receiving pelvic radiation but no difference in overall survival. A subset analysis of this study was among the first to report that patients with high-risk features, such as deep invasion and high grade, were most likely to benefit from adjuvant pelvic irradiation. In this updated report, after a median follow-up time of 20 years, there was still no difference in overall survival between the 2 arms except in women younger than 60. In this population, overall survival was lower in those receiving pelvic radiation. The decrement in survival was attributed in part to a 2-fold higher rate of secondary malignancies in the younger women who received pelvic radiation therapy.