AbstractsOne hundred and thirty-eight patients were treated at New York Medical College and affiliated hospitals from 1974 to 1979 for endometrial carcinoma. A total of 38 patients had received 4500 rad of preoperative x-ray therapy to the pelvis.All patients underwent exploratory laparotomy. One hundred twenty-nine patients underwent extrafascial total abdominal hysterectomy with bilateral salpingo-oophorectomy and nine patients with stage II disease underwent radical hysterectomy with bilateral salpingo-oophorectomy. The pelvic and paraaortic nodal regions were examined. All palpable nodes that were suspicious for malignancy were biopsied.All patients without evidence of gross or microscopic nodal disease had no adjunctive therapy. Those patients with evidence of pelvic nodal metastases only received 4500 rad of x-ray therapy to the pelvis postoperatively. When histologically confirmed paraaortic disease was appreciated, the patients were offered 5000 rad of x-ray therapy to the paraaortic region as well as 4500 rad of x-ray therapy to the pelvis. Only two of 20 patients refused this adjunctive therapy. In addition, a daily dose of 160 mg of Megace was administered to all patients that accepted x-ray therapy to the paraaortic fields.One hundred ten of 138 patients had stage I disease (79.7 per cent), 15 had stage II disease (10.8 per cent), 11 had stage III disease (7.9 per cent), and two had stage IV disease (1.4 per cent). Of the 110 patients with stage I endometrial carcinoma, 49 had well-differentiated tumor (44.5 per cent of all stage I cases), 38 had moderately differentiated tumor (34.5 per cent), and 23 had poorly differentiated tumor (21 per cent). The histology for these tumors was identified as either adenocarcinoma or adenocanthoma.Positive pelvic nodes were identified in 10 per cent of stage I and 22 per cent of stage II patients. The incidence of pelvic nodal metastases by grade in stage I disease was 2 per cent G1, 8 per cent G2, and 30 per cent G3.Paraaortic nodes were positive in 12.7 per cent of stage I cases, 33 per cent of stage II cases, 45 per cent of stage III cases, and 100 per cent of stage IV cases. Those stage I patients with G1 histology had 2 per cent positive paraaortic nodes, G2, 11 per cent; and G3, 39 per cent. The incidence of paraaortic metastases, with respect to either microscopic or gross disease, increased with worsening grade—G1,0 per cent; G2,25 per cent; G3, 44.5 per cent.The individual results of a minimum of 5-year follow-up for all patients with histologically proven and treated paraaortic disease is illustrated in Table 1. One patient with stage I G2 microscopic disease developed small bowel obstruction and eventually necessitated laparotomy. Another patient with stage I G3 gross nodal disease developed small bowel obstruction but responded to therapy with a long tube. Two patients refused adjunctive radiotherapy; one patient (stage IG3) was lost to follow-up and the other patient (stage I G2) died at 33 months.There was no evidence of disease in five of eight patients (62.5 per cent) with stage I microscopic paraaortic disease. In stage I gross nodal disease, there were no survivors (0/ 4). Of those patients with stage I microscopic nodal disease who did not survive, all had a grade 3 tumor. Two of three patients with stage II microscopic nodal disease after treatment are no evidence of disease. Most strikingly only one of six (17 per cent) patients who had gross paraaortic disease and received adjunctive therapy is alive at follow-up, whereas eight of 12 (67 per cent) patients with microscopic nodal disease and adjunctive therapy had no evidence of disease at follow-up.