Federation Of Gynecology And Obstetrics Stage IA Research Articles

Quality of therapy in early ovarian cancer: results of the quality assurance program of the AGO Study Group

ObjectiveThe quality assurance program for ovarian cancer (QS-OVAR) evaluates the implementation of treatment standards and impact on survival for International Federation of Gynecology and Obstetrics (FIGO) stage I ovarian cancer.MethodsPatients...

Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence

ObjectiveAdult granulosa cell tumors represent less than 5% of all ovarian malignancies. The aim of this study was to analyze the clinicopathological parameters and their impact on progression-free and overall...

Defining the Optimal Treatment Strategy in Patients With Uterine Serous Carcinoma

AimsUterine serous carcinoma (USC) is an aggressive subtype of endometrial cancer with high rates of relapse and death. As adjuvant therapy might be beneficial in early-stage disease, the impact of standard complete surgical staging is questioned. Therefore, we wanted to explore the optimal treatment strategy for women diagnosed with USC. Materials and methodsA retrospective multicentre study of women diagnosed with primary USC in the UK and the Netherlands. Treatment strategy in relation to overall survival and progression-free survival was recorded and evaluated with Kaplan–Meier and Cox regression analysis. Furthermore, primary surgical staging and/or adjuvant treatment in relation to patterns of recurrence were evaluated. ResultsIn total, 272 women with a median age of 70 years were included. Most patients presented with International Federation of Gynecology and Obstetrics (FIGO) stage I disease (44%). Overall, 48% of patients developed recurrent disease, most (58%) with a distant component. Women treated with chemotherapy showed significantly better overall survival (hazard ratio 0.50, 95% confidence interval 0.31–0.81; P = 0.005) and progression-free survival (hazard ratio 0.48, 95% confidence interval 0.28–0.80; P = 0.04) in multivariable analysis. Furthermore, even in surgically staged women with FIGO stage IA disease, a high recurrence rate of 42% was seen. ConclusionWomen with USC who received adjuvant chemotherapy showed better survival rates compared with those who received other or no adjuvant treatment. The benefit of adjuvant chemotherapy was observed across all tumour stages, including surgically staged FIGO stage IA. These data question the role of surgical staging in the absence of macroscopic disease in USC.

The Impact of Adjuvant Management Strategies on Outcomes in Women With Early Stage Uterine Serous Carcinoma.

ObjectiveTo determine the impact of different adjuvant strategies on outcomes in women with early-stage uterine serous carcinoma (USC).MethodsOur retrospective database for women with endometrial carcinoma was queried for women with 2009 International Federation of Gynecology and Obstetrics (FIGO) stages I-II USC who underwent surgical staging between January 1991 and April 2019 followed by adjuvant management (observation, radiation therapy (RT), chemotherapy (CT), or combined modality treatment (CRT)). Chi-square tests were performed to compare differences in outcome by type of adjuvant management. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were assessed by Kaplan-Meier and log-rank tests. Univariate and multivariate analyses (MVA) were performed to identify statistically significant predictors of survival endpoints.ResultsWe identified 171 women who met our inclusion criteria. The median follow-up time was 70.5 months. Seventy-five percent of the study cohort was FIGO stage IA, 13% were stage IB, and 12% were stage II. All women underwent pelvic lymph node dissection with a median number of dissected lymph nodes of 14. Omentectomy was performed in 64% of patients. Adjuvant RT was utilized in 56% of women (65 patients received vaginal brachytherapy alone, 10 patients received pelvic RT, and 21 patients received a combination of both). The most commonly used chemotherapy regimen was carboplatin and paclitaxel with a median number of cycles of six. A total of 44% of the cohort received CRT, 12% received RT alone, 19% received chemo alone, and 25% were observed. Five-year RFS was 73% for those who received CRT, 84% for those who received RT alone, 68% for those who received CT alone, and 55% for those who were observed (p=0.13). Five-year DSS was 81%, 94%, 71%, and 60%, respectively (p=0.02). Five-year OS was 76%, 70%, 60%, and 56%, respectively (p=0.11). On MVA of OS and DSS, a higher percentage of myometrial invasion, the presence of lower uterine segment involvement, positive peritoneal cytology, and receipt of chemotherapy alone/observation were independent predictors of worse outcomes. The sole independent predictor of worse RFS on MVA was the presence of positive peritoneal cytology.ConclusionIn this cohort of women with early-stage USC who underwent surgical staging, adjuvant radiation treatment with or without chemotherapy was associated with improved survival endpoints and trended toward improved recurrence rates.

Adjuvant brachytherapy for FIGO stage I serous or clear cell endometrial cancer

ObjectivesOptimal adjuvant treatment for early-stage clear cell and serous endometrial cancer remains unclear. We report outcomes for women with surgically staged International Federation of Gynecology and Obstetrics (FIGO) stage I...

Dynamic contrast‐enhanced ultrasound improves diagnostic performance in endometrial cancer staging

To compare the sensitivity and specificity of conventional two-dimensional transvaginal ultrasound/power Doppler (2D-TVU/PD) alone and 2D-TVU/PD combined with dynamic contrast-enhanced ultrasound (DCE-US) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) in women with endometrial cancer (EC), and to assess the association of DCE-US semiquantitative and qualitative variables with International Federation of Gynecology and Obstetrics (FIGO) Stage ≥ IB and 'high-risk' cancer. This was a prospective study of 101 consecutive women with biopsy-confirmed EC, undergoing expert ultrasound examination at Karolinska University Hospital, a tertiary referral center. All consenting women underwent DCE-US using a 1.5-2.5-mL intravenous bolus of SonoVue contrast agent, as well as conventional 2D-TVU/PD examination. DCE-US videoclips were analyzed with regard to filling (global or focal), wash-in (prior, simultaneous or after) and wash-out (global or focal) patterns of the contrast agent in the tumor compared with the surrounding tissue, as well as semiquantitative DCE-US parameters (wash-in slope, time-to-peak, peak intensity and area under the time-intensity curve (TIC)) obtained from a TIC. The study cohort was compared with a control cohort of women with EC examined at our center according to the International Endometrial Tumor Analysis protocol using 2D-TVU/PD only, matched at a ratio of 3:1 for FIGO stage and grade. The sensitivity and specificity of 2D-TVU/PD alone in the control cohort and in combination with DCE-US in the study cohort in the diagnosis of deep MI, CSI and high-risk cancer (defined as FIGO Stage ≥ IB and/or Grade 3 endometrioid and/or non-endometrioid histology) were compared, using pathological evaluation after hysterectomy as the 'gold standard'. After exclusions, 93 women were included in the study cohort and were matched to 279 women in the control cohort. The prevalence of FIGO Stage IA, Grade 1-2 EC was 52% in both cohorts. The sensitivity of 2D-TVU/PD with DCE-US in the study cohort was higher than that of 2D-TVU/PD alone in the control cohort in diagnosing both deep MI (0.74 vs 0.62; P = 0.036) and CSI (0.75 vs 0.51; P < 0.001), whereas the specificity was not significantly different (0.87 vs 0.85 and 0.96 vs 0.95, respectively). Compared with 2D-TVU/PD alone, the specificity of 2D-TVU/PD with DCE-US was higher in detecting high-risk cancer (0.94 vs 0.85; P = 0.024) but the sensitivity did not differ (0.73 vs 0.71). High-risk cancer and FIGO Stage ≥ IB were characterized by a 'focal' filling pattern, with a 'prior' wash-in pattern and a 'focal' wash-out pattern on subjective assessment of DCE-US videoclips. All semiquantitative DCE-US parameters were significantly predictive of FIGO Stage ≥ IB but not of high-risk cancer, despite a clear trend. Compared with 2D-TVU/PD alone, combining 2D-TVU/PD with DCE-US can significantly improve the detection of deep MI and CSI in women with EC, without increasing the false-positive rate. It can also improve the correct classification of high-risk disease, mainly by increasing specificity, thereby possibly reducing the number of unnecessarily extensive surgeries by almost 10%. Semiquantitative DCE-US parameters, as well as a 'focal' filling pattern, endometrial wash-in prior to the myometrium and a 'focal' wash-out pattern, are all associated with more advanced disease. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Expression of CD133 and Aldehyde Dehydrogenase 1A1 in Borderline Ovarian Tumor and Their Correlation with International Federation of Gynecology and Obstetrics

BACKGROUND: Borderline ovarian tumor (BOT) is an epithelial ovarian tumor with atypical epithelial proliferation without stromal invasion. BOTs may have an aggressive fashion with associated microinvasion feature, peritoneal “implants,” regional lymphadenopathy, and higher International Federation of Gynecology and Obstetrics (FIGO) stage. CD133 is cancer stem cells (CSCs) marker that promotes cell proliferation and tumor invasion through induction of nuclear factor kappa B and upregulation of MMP9. Aldehyde dehydrogenase 1A1 (ALDH1A1) is CSCs marker that promotes cell proliferation through the upregulation of c-MYC and cyclin-D1.&#x0D; AIM: The aim of this study was to investigate the correlation between CD133 and ALDH1A1 expression with FIGO stage. This research was performed as an analytic-observational with a cross-sectional design.&#x0D; METHODS: This research using a paraffin block of patients diagnosed as BOT in Hasan Sadikin Hospital Bandung. Samples were divided in two groups: FIGO stage IA and FIGO stage &gt;IA. All samples were stained by immunohistochemistry CD133 and ALDH1A1. All data were analyzed using the Chi-square test with a significant level 5%.&#x0D; RESULTS: This study showed a statistically significant correlation between CD133 (p = 0.047) and ALDH1A1 (p = 0.042) expression with FIGO stage in BOT. Multivariate analysis showed there was no correlation between CD133 and ALDH1A1 in the affected of FIGO stage in BOT.&#x0D; CONCLUSION: CD133 and ALDH1A1 in BOT can be considered as a factor to predict the prognosis of BOT through predict FIGO stage.

Pathologic Staging of Endometrial Carcinomas: Selected Areas of Difficulty.

Accurate staging of cancers is an important determinant of prognosis and guides optimal patient treatment. Although the International Collaboration on Cancer Reporting recommends that endometrial cancers (including carcinosarcomas) are pathologically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 system, in many areas TNM [American Joint Committee on Cancer (AJCC) or Union for International Cancer Control (UICC)] staging is used or even mandated; these latter systems are based on FIGO 2009. In this review, areas of difficulty in the pathologic staging of endometrial carcinomas are covered with practical advice for the reporting pathologist. These include issues regarding the assessment of the depth of myometrial involvement (which may be rendered difficult due to a variety of factors), tumor involvement of adenomyosis, and assessment of cervical and uterine serosal involvement. Although not included in the FIGO staging system, the issue of lymphovascular space invasion (LVSI) is covered as this is of prognostic importance and there are multiple problems in the pathologic assessment of this. One important point is that tumors should not be upstaged based on the presence of LVSI alone without tissue involvement; for example, the presence of LVSI in the outer half of the myometrium or in cervical or adnexal vessels in a carcinoma with myoinvasion confined to the inner half of the myometrium is still FIGO stage IA. The issue of simultaneously occurring tumors of the endometrium and adnexa is also covered with advice on how to distinguish between synchronous independent and metastatic neoplasms of both endometrioid and nonendometrioid types. Recent molecular evidence showing that simultaneously occurring endometrioid carcinomas of the endometrium and ovary are clonal and thus probably represent metastatic disease from the endometrium to the ovary rather than synchronous independent neoplasms, as is widely assumed, is discussed.

Utility of tumor marker HE4 as prognostic factor in endometrial cancer: a single-center controlled study.

This study aims to investigate the correlation between preoperative human epididymis protein 4 (HE4) levels, endometrial cancer (EC) staging, and ideal cutoff for stage prediction. All EC patients, treated within January 2009 and February 2014 at the Division of Gynaecologic Oncology of the University Campus Bio-Medico of Rome, were considered for the study. For the first part of the study, we consider an HE4 cutoff of 70 pmol/L. Histotypes (endometrioid versus non-endometrioid), grading (G1, G2, G3), and stage were correlated with HE4 levels. In the second part of the study, the logistic regression was performed in stepwise mood to identify the ideal HE4 cutoff for stage prediction. Two hundred thirty-two patients with surgically staged EC and preoperative HE4 dosage were included in the study. We found that higher HE4 levels correlate with undifferentiated grading (p < 0.05). Moreover, we found that 42, 77, 90, 93 and 100 % of patients classified as International Federation of Gynecology and Obstetrics (FIGO) stage IA, IB, II, III, and IV, respectively, presented HE4 levels above the standard cutoff of 70 pmol/L. Based on receiver operating characteristic (ROC) curves, we found the ideal HE4 cutoff as follows: 61.3 pmol/L for FIGO stage IA (sensitivity = 82.3 % and specificity = 96 %), 89.2 pmol/L for FIGO stage IB (sensitivity = 83.3 % and specificity = 96 %), 104.3 pmol/L for FIGO stage II (sensitivity = 80.9 % and specificity = 98.6 %), 152.6 pmol/L for FIGO stage III (sensitivity = 92.5 % and specificity = 98.6 %), and 203.8 pmol/L for FIGO stage IV (sensitivity = 81.8 % and specificity = 99.3 %). Our results suggest a potential role of HE4 in EC stage prediction.

Do FIGO Stage IA and Small (≤2 cm) IB1 Cervical Adenocarcinomas Have a Good Prognosis and Warrant Less Radical Surgery?

There is a controversy regarding the optimal management of small cervical adenocarcinomas, and more radical surgery is often undertaken compared to similar size squamous carcinomas. We wished to determine the risk of parametrial involvement and metastatic disease and the outcome in International Federation of Gynecology and Obstetrics (FIGO) stage IA and small (≤2 cm) stage IB1 cervical adenocarcinomas. All women with a diagnosis of International Federation of Gynecology and Obstetrics stages IA1, IA2, or IB1 cervical adenocarcinoma with a maximum tumor size of 2 cm were identified between 1999 and 2010 in Northern Ireland. A single pathologist reviewed all pathology prospectively at a cancer center tumor board. A total of 74 women were identified (mean age, 39 years; range, 25-72 years). In total, 36 women had stage IA1, 9 women had stage IA2, and 29 women had stage IB1 cervical adenocarcinomas. Surgical treatment ranged from local excision (cone or large loop excision of transformation zone) to radical hysterectomy and pelvic lymph node dissection; adjuvant therapy was not administered in any case. No parametrial involvement was seen in the 36 women who underwent parametrial resection. No lymph node metastasis was identified in the 45 women who underwent pelvic lymph node dissection. Lymphovascular space invasion was identified in 6 cases. No tumor recurrence or metastasis was noted during a mean follow-up of 35 months. The optimal management of women with IA or small IB1 cervical adenocarcinoma is controversial, and radical surgery is often undertaken. Our data suggest that there is an extremely low risk of parametrial and lymph node involvement with tumors 2 cm or smaller and a low recurrence rate. Less radical surgery may be warranted for small cervical adenocarcinomas, and this should be addressed by future studies.

Does the revised International Federation of Gynecology and Obstetrics staging system for endometrial cancer lead to increased discrimination in patient outcomes?

Recent changes were made to the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer. The objective of this study was to compare survival outcomes for patients who were staged according to the 1988 FIGO staging system versus the 2009 FIGO staging system. Data were obtained from the Surveillance, Epidemiology, and End Results Program for the years 1998 to 2006. Patients who had a diagnosis of adenocarcinoma of the uterus with complete staging information were included. Patients were staged according to the 1988 and 2009 FIGO staging systems, and Kaplan-Meier estimates were derived for cause-specific survival (CSS). Univariate and multivariate analyses using Cox proportional hazards models were used to identify the factors associated with survival. In total, 47,284 patients were included. The median follow-up was 37 months. The 5-year CSS rates for patients who had 2009 FIGO stage IA and IB disease were 96.6% and 89.9%, respectively (P < .0001). After accounting for age, grade, and race, this survival difference remained significant (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.74-2.24; P < .0001). Patients who had 1988 FIGO stage IIA disease had a 5-year CSS rate similar to that of patients who had 1988 FIGO stage IC disease (88.6% vs 89.9%, respectively; P = .09). Patients who had positive pelvic washings had a 5-year CSS rate similar to that of patients who had stage IIIA disease according to the 2009 FIGO system (74.2% vs 72.1%, respectively; P = .37). The 5-year CSS rate for patients who had stage IIIC1 disease was significantly improved compared with that for patients who had stage IIIC2 disease (68.2% vs 57.3%, respectively; P < .0001). In the multivariate model, the survival difference remained (HR, 1.49; 95% CI, 1.26-1.76; P < .0001). The 2009 staging system for endometrial cancer produced better discrimination in CSS outcomes compared with the 1988 system.

Validation of Tumor Size as Staging Variable in the Revised International Federation of Gynecology and Obstetrics Stage I Leiomyosarcoma

Tumor size has been introduced as a staging variable in the 2008 International Federation of Gynecology and Obstetrics (FIGO) staging system for stage I leiomyosarcoma. In the prior 1988 FIGO staging system, leiomyosarcoma used the same staging criteria as endometrial cancer including cervical involvement. In this large population-based study, we validate the use of tumor size for purposes of risk stratification among stage I leiomyosarcoma patients. Data were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Kaplan-Meier log rank and Cox proportional hazards models were used for survival analysis and to identify possible predictors for survival. The identified cohort included 819 women: 158 (19.3%), 2008 FIGO stage IA and 661 (80.7%), 2008 FIGO stage IB leiomyosarcoma. The 5-year overall survival rate was better in stage IA than in stage IB leiomyosarcoma (76.6% vs 48.4%, P < 0.001). Similarly, the 5-year overall survival rates were significantly different (P < 0.001) among women with different tumor size categories: 5 cm or smaller, 5.1 to 10 cm, and larger than 10 cm (76.6%, 52.9%, and 41.9%, respectively). The difference in 5-year overall survival rates between women with and without cervical involvement was significant (28.5% vs 55.3%, P = 0.014). Although age (P < 0.001), cervical involvement (P = 0.014), tumor grade (P < 0.001), tumor size (P < 0.001), performance of salpingo-oophorectomy (P = 0.001), and stage (P < 0.001) were all significant prognostic factors on univariate analysis, only age (P = 0.007), tumor size (P < 0.001), tumor grade (P < 0.001), and performance of salpingo-oophorectomy (P = 0.02) were significant predictors on multivariate analysis. Variables not found significant on univariate analysis (hence excluded from the Cox model) included lymphadenectomy, radiation, and race. The new staging system using tumor size is better for risk stratification in stage I leiomyosarcoma compared with the 1988 FIGO staging system of endometrial cancer.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Results of conservative treatment in epithelial ovarian carcinoma.

The objective of this study was to assess and evaluate the clinical outcome and fertility in patients treated conservatively for epithelial ovarian carcinoma (EOC). Thirty-one patients treated with conservative management EOC were followed up. Optimal surgical staging was performed in 2 cases during the initial surgery and in 27 patients during a reassessment surgery. Six patients underwent hysterectomy during this restaging surgery. Among 25 patients treated conservatively after the restaging surgery, the International Federation of Gynecology and Obstetrics (FIGO) staging distribution was 19 Stage IA (Grade 1, n = 9; Grade 2, n = 10), 1 Stage IC, 2 Stage II, and 3 patients with initial stage unknown. Seven patients had recurrence (five on the remaining ovary). The disease free survival rate at 5 years for patients with Stage IA Grade 1 and 2 tumors were 89% and 71%, respectively. All patients with Stage IA or higher disease experienced recurrence. Only four pregnancies (three spontaneous and one after in vitro fertilization procedure) were obtained. Conservative surgery for patients with EOC could be considered in young patients with Stage IA Grade 1 disease adequately staged and desiring to preserve fertility potential. This procedure should not performed in patients with disease staged higher than FIGO Stage IA.

Stage IA 1 cervical adenocarcinoma: definition and treatment

Objective: To propose a definition for stage IA 1 cervical adenocarcinoma, based on the International Federation of Gynecology and Obstetrics (FIGO) staging system, and to determine if patients meeting criteria might be candidates for conservative surgery. Methods: Two hundred women were diagnosed with early-stage cervical adenocarcinoma from 1982 to 1996. Histopathologic sections were reviewed by a gynecologic pathologist. Medical records were reviewed, and patients included in this study had microscopically identifiable lesions, up to 3 mm invasive depth, up to 7 mm tumor width, and negative margins if cone biopsy was performed. Results: Twenty-one patients with microinvasive adenocarcinoma met criteria for FIGO stage IA 1 carcinoma of the cervix. The median (range) follow-up was 76 (30–172) months and median (range) patient age was 38 (24–75) years. Definitive treatment included type II or III radical hysterectomy in 16 cases, simple abdominal or vaginal hysterectomy in four cases, and loop electrosurgical excision procedure in one case; one patient received adjuvant pelvic radiation. The histologic subtypes were endocervical adenocarcinoma in 18 cases, adenosquamous carcinoma in two cases, and clear-cell adenocarcinoma in one case. There was no evidence of parametrial invasion or lymph node metastases in any patient who had radical surgery, and there were no disease recurrences. Conclusion: Patients with microinvasive adenocarcinoma who met criteria for FIGO stage IA 1 cervical carcinoma had disease limited to the cervix, and conservative surgery, such as cone biopsy or simple hysterectomy, might offer them definitive treatment.

Juvenile Granulosa Cell Tumors of the Ovary in Children and Adolescents: Results from 33 Patients Registered in a Prospective Cooperative Study

Clinical and pathological data from 33 prospective registered patients who suffered from juvenile granulosa cell tumors (JGCT) were evaluated according to treatment and outcome. The median age at the time of diagnosis was 7.6 years (range, 6 months to 17.5 years). Fourteen patients showed signs of a pseudo-precocious puberty. In 1 patient premenarcheal bleeding was the only clinical symptom of the disease. A pelvic tumor or an abdominal distention was found in 6 children, revealing signs of an acute abdomen in 3 children. Tumor staging was performed according to the FIGO (International Federation of Gynecology and Obstetrics) classification for ovarian tumors. Twenty children and adolescents were classified as FIGO stage Ia; 8 children had stage Ic tumors. In 4 patients stage IIc and in 1 patient stage IIIc tumors were observed. For local tumor control all 33 patients underwent tumor resection and oophorectomy, which was complete in 28 patients. Adjuvant combination chemotherapy was used in 1 girl who presented with high mitotic pathological index features in FIGO stage Ia. In 8 other children between FIGO stage Ic and IIIc, treatment was also intensified by multidrug chemotherapy. After a follow-up period of 168 months, an event-free survival of 0.75 ± 0.07 was observed. From our data we conclude that multidrug chemotherapy including cisplatin-based regimens may be useful to enhance treatment results of JGCT, especially in advanced FIGO stages.

Postoperative vaginal cuff irradiation using high dose rate remote afterloading: A Phase II clinical protocol

In September 1989, a postoperative Phase II high dose rate (HDR) brachytherapy protocol was started for International Federation of Gynecology and Obstetrics (FIGO) Stage I endometrial adenocarcinoma. This review reports the overall survival, local control, and complication rates for the initial 63 patients treated in this Phase II study. High dose rate brachytherapy was delivered using an Iridium-192 HDR remote afterloader. Sixty-three patients were entered into the Phase II protocol, each receiving two vaginal cuff treatments 1 week apart (range 4-12 days) with vaginal ovoids (diameter 2.0-3.0 cm). No patient received adjuvant external beam radiation. A dose of 32.4 Gy in two fractions was prescribed to the ovoid surface in 63 patients. The first three patients treated at our institution received 15, 16.2, and 29 Gy, respectively, to determine acute effects. At a median follow-up of 1.6 years (range 0.75-4.3 years) no patient has developed a vaginal cuff recurrence. One regional recurrence (1.6%) occurred at 1.2 years at the pelvic side wall. This patient is alive and without evidence of disease 7 months after completion of salvage irradiation, which resulted in the only vaginal stenosis (1.6%). Fourteen patients (22%) experienced vaginal apex fibrosis by physical exam, which was clinically symptomatic in four patients. Two patients reported stress incontinence; however, these symptoms were noted prior to their HDR therapy. One patient died 2.4 years after HDR therapy due to cardiovascular disease without evidence of cancer at autopsy. Preliminary results of our phase II HDR vaginal cuff protocol for postoperative FIGO Stage IA, Grade 3 or Stage IB, Grade 1-2 patients demonstrate that 32.4 Gy in two fractions is well tolerated by the vaginal cuff mucosa. Local control appears comparable to our prior experience and others with low dose rate (LDR) brachytherapy. Additional patient accrual and further follow-up will better determine the late morbidity, local control, and overall survival of these patients.