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Primary Radiotherapy Versus Surgery in Early-Stage Endometrial Cancer Among High-Risk Surgical Patients: A Retrospective Comparative Study
by
, , , , , ,
Lucia Gómez-Lavin Fernández
1
,
Sergi Fernández-González
2,
Dina Najjari-Jamal
3,*,
Lola Marti Cardona
2,
Marc Juarez Lozano
3,
Marc Barahona
2,
Marta Gil Martin
4,
Beatriz Pardo Burdalo
4,
Andrea Slocker Escarpa
3,
Milica Stefanovic
3,
Cristina Gutiérrez Miguelez
5 and
Jordi Ponce Sebastià
2 1
Department of Obstetrics and Gynecology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08202 Sabadell, Barcelona, Spain
2
Department of Gynecology, Hospital de Bellvitge, University of Barcelona, 08907 l’Hospitalett de Llobregat, Barcelona, Spain
3
Department of Radiation Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge—Comprehensive Cancer Center, 08908 l’Hospitalet de Llobregat, Barcelona, Spain
4
Department of Medical Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge—Comprehensive Cancer Center, 08908 l’Hospitalett de Llobregat, Barcelona, Spain
5
Department of Radiation Oncology, Hospital del Mar, 08003 Barcelona, Spain
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(11), 1858; https://doi.org/10.3390/cancers18111858 (registering DOI)
Submission received: 5 May 2026
/
Revised: 20 May 2026
/
Accepted: 26 May 2026
/
Published: 5 June 2026
(This article belongs to the Special Issue Endometrial Cancer Therapy: Foundations and Future Directions)
Simple Summary
A proportion of patients with early-stage endometrial cancer cannot undergo surgery due to severe obesity, advanced age, or other medical conditions. In these cases, radiotherapy may offer a curative alternative, although direct comparisons with surgery remain limited. In this study, we compared two similar groups of patients with early-stage disease (FIGO 2009 stage I–II): one treated with radiotherapy and the other with surgery. Both approaches achieved comparable outcomes in terms of cancer control, survival, and risk of recurrence, with no significant differences in severe treatment-related complications. These findings support radiotherapy as an effective and well-tolerated treatment option for patients who are not suitable for surgery, helping guide treatment decisions in medically high-risk populations.
Abstract
Background/Objectives: Surgery is the standard treatment for early-stage endometrial cancer (EC); however, some patients are medically inoperable due to comorbidities or morbid obesity. Definitive image-guided brachytherapy (BT) with or without external beam radiotherapy (EBRT) is a curative alternative, although comparative data with surgery remains limited. This study compared cancer-specific survival (CSS) at 2 and 5 years in high-risk surgical patients with early-stage EC (FIGO 2009 I–II), treated with definitive radiotherapy or surgery. Secondary endpoints included overall survival (OS), recurrence-free survival (RFS), disease-free survival (DFS), and toxicity. Methods: Retrospective comparative study including 72 patients treated between 2011 and 2023: 36 medically inoperable treated with BT +/- EBRT and 36 matched undergoing surgery. Survival outcomes were estimated using Kaplan–Meier methods and compared using log-rank tests. Results: Median age was 74 years and mean BMI was 38.1 kg/m2; 75% were morbidly obese, with endometrioid carcinoma being the predominant histology (88.9%). Five-year CSS was 97.2% in the radiotherapy group versus 91.7% in the surgery group (p = 0.39). Five-year RFS was identical in both groups (86.1%), with recurrence rates of 13.9%. Five-year OS was lower in the radiotherapy group (66.7% vs. 77.8%; p = 0.3), without statistical significance. Grade ≥3 radiotherapy-related toxicity occurred in 19.4%, whereas severe surgical complications occurred in 8.3%. Conclusions: Definitive BT ± EBRT is an effective and well-tolerated curative option for medically inoperable early-stage EC, with survival and recurrence outcomes comparable to surgery, supporting its role as a valid therapeutic alternative in high-risk surgical patients.
