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review reminds us that simple vaginal hysterectomy is often curative in women with endometrial cancer. In this series of 128 women over age 70 with endometrial cancer, the 5-year survival rate was 89.2% for stage I disease and a very respectable 67.4% for 33 women with stage II or III disease. All patients had a bilateral salpingo-oophorectomy, but only 8.6% of these women had a pelvic lymphadenectomy through an extraperitoneal approach. Others, including Chan et al from the University of California at Irvine, have also reported excellent results with minimal morbidity in a series of 51 medically compromised women with endometrial cancer (Obstet Gynecol 2001;97: 707). Most of these women were morbidly obese and many had 3 or more risk factors. Morbidity was minimal and 5-year survival was 88%.Although radiation therapy alone has been used to treat women with endometrial adenocarcinoma, older reports have indicated a worse outcome than when hysterectomy is part of the treatment, and there are no recent studies that have examined this question. In a study of 34 women over age 75 with endometrial cancer, Citron et al found minimal morbidity when pelvic radiation was added to surgery for high-risk disease (Int J Radiat Biol Phys 2004;59:1432). The 5-year disease-free survival was actually better in the women treated with radiation for deep myometrial invasion, cervical involvement, or poorly differentiated adenocarcinoma.Laparoscopically assisted hysterectomy has also been used for older women with endometrial cancer with good results (Scribner et al. Gynecol Oncol 2001;83:563). However, operative time and surgical morbidity are usually greater than with abdominal hysterectomy and staging. Once again, the value of lymphadenectomy in the survival of women with endometrial cancer is very much in question.-HWJ)