{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T10:06:06Z","timestamp":1781085966219,"version":"3.54.1"},"reference-count":33,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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\u2013II), 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 +\/\u2212 EBRT and 36 matched undergoing surgery. Survival outcomes were estimated using Kaplan\u2013Meier 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 \u22653 radiotherapy-related toxicity occurred in 19.4%, whereas severe surgical complications occurred in 8.3%. Conclusions: Definitive BT \u00b1 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.<\/jats:p>","DOI":"10.3390\/cancers18111858","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:18:16Z","timestamp":1780679896000},"page":"1858","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary Radiotherapy Versus Surgery in Early-Stage Endometrial Cancer Among High-Risk Surgical Patients: A Retrospective Comparative Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4554-3928","authenticated-orcid":false,"given":"Lucia","family":"G\u00f3mez-Lavin Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Parc Taul\u00ed Hospital Universitari, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona, 08202 Sabadell, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergi","family":"Fern\u00e1ndez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital de Bellvitge, University of Barcelona, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7815-2870","authenticated-orcid":false,"given":"Dina","family":"Najjari-Jamal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge\u2014Comprehensive Cancer Center, 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lola","family":"Marti Cardona","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital de Bellvitge, University of Barcelona, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9695-6459","authenticated-orcid":false,"given":"Marc","family":"Juarez Lozano","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge\u2014Comprehensive Cancer Center, 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9969-5628","authenticated-orcid":false,"given":"Marc","family":"Barahona","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital de Bellvitge, University of Barcelona, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8548-5355","authenticated-orcid":false,"given":"Marta","family":"Gil Martin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge\u2014Comprehensive Cancer Center, 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Pardo Burdalo","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge\u2014Comprehensive Cancer Center, 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Slocker Escarpa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge\u2014Comprehensive Cancer Center, 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9293-4385","authenticated-orcid":false,"given":"Milica","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Catalan Institute of Oncology, Campus Salut Bellvitge\u2014Comprehensive Cancer Center, 08908 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Guti\u00e9rrez Miguelez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital del Mar, 08003 Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0613-2261","authenticated-orcid":false,"given":"Jordi","family":"Ponce Sebasti\u00e0","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Hospital de Bellvitge, University of Barcelona, 08907 L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.brachy.2017.01.011","article-title":"Management of elderly patients with early-stage medically inoperable endometrial cancer: Systematic review and National Cancer Database analysis","volume":"16","author":"Dutta","year":"2017","journal-title":"Brachytherapy"},{"key":"ref_2","unstructured":"World Cancer Research Fund (2026, April 27). 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