ABSTRACT
Endometrial cancer is the most common gynecologic cancer in the USA with 39300 cases reported in 2002.1 Endometrial cancer is also one of the most curable gynecologic cancers. Although there is no screening test, the majority of patients present when the cancer is limited to the uterus. Early symptoms-in particular, postmenopausal bleeding-lead to early detection. For this reason, there were only 6300 deaths from endometrial cancer in the USA in 2002.1
Until the 1980s, most patients with endometrial cancer were treated with a combination of surgery and radiotherapy Radiotherapy was commonly delivered prior to surgery, this sequence being preferred for a number of reasons. First, radiotherapy was thought to sterilize the lymph nodes and surgical bed: it was commonly believed that preoperative brachytherapy would prevent intraoperative dissemination caused by manipulation of the uterus during surgery. It was also believed that surgery might compromise the effectiveness of postoperative radiotherapy by interfering with tissue oxygenation in the surgical bed. Another reason preoperative radiotherapy was preferred is that it was feared that postoperative adhesions in the pelvis increased the risk of radiation enteritis and proctitis from postoperative radiotherapy Once the pelvis was irradiated, there was no need for surgical treatment of the pelvic nodes.2
