We read, with great interest, the article by Sharma et al, in which, in a large retrospective study on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database, the authors analyzed women with stages I-II endometrioid adenocarcinomas of the uterine corpus treated between 1988 and 2006. Findings suggest that, especially among women with high- to intermediate-risk tumors, patients who undergo lymphadenectomy are less likely to receive external-beam radiation. According to the authors, data support lymphadenectomy for the majority of women with endometrial carcinoma, thus sparing radiation-related morbidity and costs.

The debate concerning the proper indications for additional surgical procedures like lymphadenectomy, as well as postoperative treatments, is longstanding.

Both prospective randomized trials evaluating hysterectomy, with or without lymph node dissection, showed pelvic lymphadenectomy does not influence survival, with findings subsequently confirmed by a metaanalysis.

Likewise, in spite of variegated retrospective analyses of selected groups of patients, aortic lymphadenectomy failed to demonstrate survival benefit in any prospective trials.

As to adjuvant therapies, we agree with the authors that an optimal treatment is still unknown. Many trials demonstrated that radiation may improve local control without any impact on overall survival for patients affected by uterine-confined disease.

In our opinion, the question should not be whether lymphadenectomy alters adjuvant radiation rate but rather whether nodal resection could have an impact on the natural history of endometrial carcinoma.

Data seem to suggest nodal status may represent a collateral marker of biological disease aggressiveness, without providing definitive indications on cancer spread.

To date, there is no reliable marker to identify high-risk patients, needing strict follow-up, with or without adjuvant treatments.

In a randomized trial of women with apparent stages I-IIA endometrial cancer (Post-Operative Radiation Therapy for Endometrial Carcinoma-2), vaginal brachytherapy resulted not inferior to pelvic radiation in preventing locoregional relapse.

So, are we going down the wrong road?

It appears illogical to avoid a treatment jeopardized by considerable morbidity and costs without survival benefit (ie, radiotherapy) by choosing another procedure (ie, lymphadenectomy), this too blighted by costs and morbidity, with no proven survival benefit.

Until we have reliable biomolecular markers, brachytherapy seems a reasonable choice when aiming for locoregional control, especially for nonsexually active women, or else chemotherapy treatment could be used to control a suspected systemic spread of disease.

In these cases, without pelvic radiotherapy, salvage lymphadenectomy could be safely performed in the case of nodal relapse.