Abstract 190: Prediction of Intracranial Aneurysm Growth Based on Morphology

Introduction: Recent studies have strongly associated intracranial aneurysm growth with increased risk of rupture. To plan more effective monitoring and intervention strategies, it would be beneficial to identify aneurysms which are likely to grow. Hypothesis: Morphological characteristics at initial diagnosis differ between unruptured intracranial aneurysms that will grow and those that are stable. Methods: A total of 58 cases of aneurysms in our medical center with follow-up imaging dates in 2015 were selected. All CTA images for the aneurysms were collected, for a total of 250 image sets. Aneurysm 3D geometry was reconstructed and morphological characteristics, including volume, surface area, and non-sphericity index (NSI) were calculated. NSI was calculated as 1 - (18π) 1/3 V 2/3 /S, where V and S represent aneurysm volume and surface area, respectively. Statistical comparisons were made using a two-tailed t-test with an assumption of unequal variance (Welch’s t-test). Results: Aneurysms were followed for an average of 50.5±50.9 months, with an average of 3.29±2.66 follow-up imaging dates. 9 aneurysms exhibited a size increase (>0.6mm) and the remaining 49 aneurysms did not. Based on their maximum diameter, no significant difference was found between initial aneurysm size between the growth (3.80±1.72 mm) and non-growth (4.26±2.00 mm) groups (p=0.13). Likewise, no significant differences in volume or surface area were found (p=0.33, p=0.36, respectively). However, initial NSI was found to be significantly higher in the growth (0.32±0.11) vs. the non-growth (0.23±0.08) group (p=0.049). Conclusions: Among aneurysms with similar size, NSI may be useful for identifying aneurysms which are more likely to grow and planning monitoring strategies accordingly. Higher initial NSI in the aneurysms which eventually grew is consistent with previous findings that higher NSI correlates with increased risk of rupture.

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Abstract WP86: Early Detection of Aneurysm Growth by Volume and Surface Area Analysis Using 3D Modeling From CT Angiography

Stroke ◽

10.1161/str.48.suppl_1.wp86 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hajime Yokota ◽

Aichi Chien ◽

Emiko Morimoto ◽

Pablo Villablanca ◽

Noriko Salamon

Keyword(s):

Surface Area ◽

Maximum Diameter ◽

Parent Artery ◽

Slice Thickness ◽

Roc Curve Analysis ◽

Unruptured Aneurysms ◽

Increased Risk ◽

Risk Of Rupture ◽

Aneurysm Growth

Introduction: Enlargement of unruptured aneurysms indicates an increased risk of rupture. Assessment of aneurysm growth is typically based on aneurysm max diameter. However, this method is often unreliable due to factors such as the degree of contrast enhancement, tilting among studies and artifacts. Hypothesis: Three-dimensional modeling can help to judge aneurysm growth. Methods: All aneurysm patients who underwent CTA (1.0-mm slice thickness) with at least one follow-up in 2015, were reviewed. Intracranial saccular aneurysms were selected and fusiform, dissecting and mycotic aneurysms were excluded. Growth was defined as more than a 0.5 mm increase in size compared with the first study. 3D models were created from the source data using 3D-slicer (http://www.slicer.org). Aneurysm extraction from the parent artery was performed semi-automatically and volume and surface area were calculated using vascular toolkit (http://www.vmtk.org). The Mann-Whitney test and ROC curve analysis were applied to compare cases which increased in size with no-change cases. Results: This research included 59 aneurysms in 51 patients that underwent 250 CTA, with follow-up duration of 50.0 ± 50.5 months. Nine aneurysms increased in size. In 5 of 9 cases, follow-up studies prior to growth detection were available. In these cases, maximum diameter change from the first study was not significant (P = 0.169). By contrast, volume and area were significantly different (P = 0.046 and 0.046, respectively). On ROC analysis, AUCs of maximum diameter, volume, and area changes were 0.7, 0.772 and 0.772. Conclusions: Calculating volume and area changes was useful to judge aneurysm growth earlier than size measurement.

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PHASES Score for Prediction of Intracranial Aneurysm Growth

Stroke ◽

10.1161/strokeaha.114.008198 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1221-1226 ◽

Cited By ~ 68

Author(s):

Daan Backes ◽

Mervyn D.I. Vergouwen ◽

Andreas T. Tiel Groenestege ◽

A. Stijntje E. Bor ◽

Birgitta K. Velthuis ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Cox Regression ◽

Continuous Variable ◽

Aneurysm Rupture ◽

Hazard Ratios ◽

Unruptured Intracranial Aneurysms ◽

Increased Risk ◽

Risk Of Rupture ◽

Aneurysm Growth

Background and Purpose— Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. Methods— In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. Results— We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5–10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22–1.43). With the lowest quartile of the PHASES score (0–1) as reference, hazard ratios were for the second (PHASES 2–3) 1.07 (95% CI, 0.49–2.32), the third (PHASES 4) 2.29 (95% CI, 1.05–4.95), and the fourth quartile (PHASES 5–14) 2.85 (95% CI, 1.43–5.67). Conclusions— Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture.

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Ten-year single-centre experience with type II endoleaks: Intervention versus observation

Vascular Medicine ◽

10.1177/1358863x17704315 ◽

2017 ◽

Vol 22 (4) ◽

pp. 316-323 ◽

Cited By ~ 9

Author(s):

Ikram-Ul Haq ◽

Arun Kelay ◽

Meryl Davis ◽

Jocelyn Brookes ◽

Tara M Mastracci ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Time Frame ◽

Type Ii ◽

Risk Of Mortality ◽

Surveillance Imaging ◽

Increased Risk ◽

Significant Difference ◽

Aneurysm Growth ◽

Aneurysm Repair

Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21.0%) developed a T2L and intervention was undertaken in 28 (34.6%): 17 (60.7%) were treated via a transarterial approach (TA) and 11 (39.3%) using the translumbar approach (TL). Fifty-three patients (65.4%) with T2Ls were managed conservatively. Patients who received T2L treatment had a greater proportion of recurrent T2Ls than patients who were conservatively managed ( p=0.032). T2Ls associated with aneurysmal growth were more resistant to treatment than those where there was no change or a decrease in aneurysm size during follow-up (0.033). There was no significant difference in the TA and TL approach with respect to endoleak repair success ( p=0.525). Treatment of a T2L did not confer a survival advantage compared to conservative management ( p=0.449) nor did the choice of either the TA or TL approach ( p=0.148). Our study suggests the development of a T2L associated with aneurysm growth may represent an aggressive phenotype that is resistant to treatment. However, this did not lead to an increased risk of mortality over follow-up. Neither a transarterial nor a translumbar approach to treating a T2L conferred superiority.

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Abstract TP295: Stroke Prevention Surgery > Quality of Life and Cognitive Ability to Drive Are Maintained After Surgical Repair of Unruptured Intracranial Aneurysm

Stroke ◽

10.1161/str.51.suppl_1.tp295 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joan M ODonnell ◽

Maurizio Manuguerra ◽

Jemma L Hodge ◽

Greg Savage ◽

Michael K Morgan

Keyword(s):

Quality Of Life ◽

Intracranial Aneurysm ◽

Surgical Management ◽

Cognitive Abilities ◽

Short Form ◽

Unruptured Intracranial Aneurysm ◽

Significant Difference ◽

Ability To Drive

Background: Studies have questioned the effectiveness of surgery for the management of unruptured intracranial aneurysm (uIA). Few studies have examined the ability to drive and quality of life (QOL) after surgery for uIA. Objective: This study examined the effectiveness of surgical management of uIA by measuring patients’ perceived quality of life and their cognitive abilities related to driving. Methods: Between January 2011 and January 2016 patients with a uIA were assessed using the Quality Metric Short Form 36 (SF36) and the off-road driver screening instrument DriveSafeDriveAware. Reassessments were conducted at the 6-week post-operative follow-up for surgical patients and at 12-month follow-up for surgical and conservatively managed patients. Results: 175 patients enrolled in the study, of which 112(66%) had surgical management of their aneurysm. For the surgical cases who completed all assessments (N=74), there was a trend for the DriveSafe pre-operative mean score of 108 (SD 10.7) to be lower than the 6-week and 12-month post-operative mean scores (111 SD 9.7 and 112 SD 10.2 respectively)(p=0.05). There were no significant changes in DriveAware scores at any epoch or between patient groups nor in the MCS in the surgical group.. There was a significant decline in PCS scores at 6 weeks post-operatively which recovered at 12 months (52 SD 8.1, 46 SD 6.8 and 52 SD 7.1 respectively)( p <0.01). There was no significant difference in 12-month mRS scores between the surgical cases who completed with cases who did not complete all assessments. Conclusion: Surgery for uIA did not affect cognitive abilities for driving at 6 weeks or 12 months after surgery. There was a decline in the QOL in the first months after surgery, however QOL returned to pre-surgical status 12 months after surgery. If the risk of seizures is low and there are no post-operative complications, returning to driving can be recommended.

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Abstract 13315: Long-term Risk of Cardiovascular Events Following Hospitalization for Sepsis: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.13315 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Leah B Kosyakovsky ◽

Federico Angriman ◽

Emma Katz ◽

Neill Adhikari ◽

Lucas C Godoy ◽

...

Keyword(s):

Systematic Review ◽

Cumulative Incidence ◽

Meta Analysis ◽

Hazard Ratios ◽

Increased Risk ◽

Significant Difference ◽

Sepsis Survivors ◽

Risk Ratios

Introduction: Sepsis results in dysregulated inflammation, coagulation, and metabolism, which may contribute to increased cardiovascular disease (CVD) risk. We conducted a systematic review and meta-analysis to determine the association between sepsis and subsequent long-term CVD events. Methods: MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception to May 2020 to identify observational studies of adult sepsis survivors (defined by diagnostic codes or consensus definitions) measuring long-term CV outcomes. The primary outcome was a composite of myocardial infarction, CV death, and stroke. Random-effects models estimated the pooled cumulative incidence and adjusted hazard ratios of CV events relative to hospital or population controls. Odds ratios were included as risk ratios assuming <10% incidence in non-septic controls, and risk ratios were taken as hazard ratios (HR) assuming no censoring. Outcomes were analyzed at maximum follow-up (primary analysis) and stratified by time (<1 year, 1-2 years, and >2 years) since sepsis. Results: Of 11,235 abstracts screened, 25 studies (22 cohort studies, 2 case-crossover studies, and 1 case-control) involving 1,949,793 sepsis survivors were included. The pooled cumulative incidence of CVD events was 9% (95% CI; 5-14%). Sepsis was associated with an increased risk (HR 1.59, 95% CI 1.37-1.86) of CVD events at maximum follow-up ( Figure ); between-study heterogeneity was substantial (I 2 =97.3%). There was no significant difference when comparing studies using population and hospital controls. Significantly elevated risk was observed up to 5 years following sepsis. Conclusions: Sepsis survivors experience an approximately 50% increased risk of CVD events, which may persist for years following the index episode. These results highlight a potential unmet need for early cardiac risk stratification and optimization in sepsis survivors.

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Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

QJM ◽

10.1093/qjmed/hcab113.030 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmed Zaky ◽

Hebatallah AM Shaaban ◽

Mohamed OA Dawoud ◽

Kareem SEF Madbouly ◽

Shaymaa M Deifalla

Keyword(s):

Mechanical Ventilation ◽

Rating Scale ◽

Neurodevelopmental Outcomes ◽

Neurodevelopmental Delay ◽

Increased Risk ◽

Study Results ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Significant Difference

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

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Plasma lipids as risk factors in relapsing nephrotic syndrome

Paediatrica Indonesiana ◽

10.14238/pi48.6.2008.322-6 ◽

2016 ◽

Vol 48 (6) ◽

pp. 322

Author(s):

Sitti Aizah Lawang ◽

Syarifuddin Rauf ◽

J. S. Lisal ◽

Husein Albar ◽

Dasril Daud

Keyword(s):

Risk Factors ◽

Nephrotic Syndrome ◽

Plasma Lipids ◽

Lipid Fraction ◽

Plasma Concentrations ◽

Increased Risk ◽

Significant Difference ◽

Remission Phase ◽

Blood Specimens

Background Nephrotic syndrome is primarily a pediatric disorderand is 15 times more common in children than in adults.Relapse rate after corticosteroid discontinuation is 39 - 59%.Hyperlipidemia is an important characteristic of nephroticsyndrome. The plasma concentrations of cholesterol, triglyceride,LDL, and VLDL are increased. Persistent hyperlipidemia afterremission can be found in frequent relapse nephrotic syndrome.Objective To determine plasma lipids as risk factor for relapsingnephrotic syndrome.Methods Thirty children with nephrotic syndrome were includedin this cohort study from March 2005 until June 2007 at WahidinSudirohusodo Hospital, Makassar. Thirty children without renal diseasewere enrolled as control. Blood specimens were collected to determineplasma lipids (cholesterol, triglyceride, LDL, and HDL) levels and LDUHDL ratio. Plasma lipids were examined in the acute and remissionphases. Follow up was carried out six months after remission todetermine the occurrence of relapsing nephrotic syndrome.Results Of 30 nephrotic syndrome patients, 12 had relapsed.There were highly significant differences in total cholesterol, HDL,LDL, triglyceride, and LDL/HDL ratio between acute nephroticsyndrome and nephrotic syndrome in remission. There were nosignificant differences in cholesterol, LDL, triglyceride, LDL!HDL ratio between nephrotic syndrome in remission and control.There was also no significant difference in the incidence in relapsebetween first attack and nephrotic syndrome with more than twoattacks. Acute lipid fraction levels were not risk factors in relapsingmephrotic syndrome. Remission triglyceride level was a risk factorin relapsing nephrotic syndrome with the prevalence risk of 5.2 andCI 95% of 1.06 to 25.3.Conclusion Persistent hypertriglyceride in remission phase isassociated with an increased risk of relapse in children withnephrotic syndrome.

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Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0040-1713861 ◽

2020 ◽

Author(s):

Nadia Nastassia Ifran ◽

Ying Ren Mok ◽

Lingaraj Krishna

Keyword(s):

Acl Reconstruction ◽

Medical Records ◽

Cruciate Ligament ◽

Acl Graft ◽

Increased Risk ◽

Significant Difference ◽

The Mean ◽

Anterior Cruciate ◽

Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

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“JUMPing into Diabetes Control”: A Group-Setting Self-Empowerment Lifestyle Intervention among Diabetes Patients

Healthcare ◽

10.3390/healthcare8020090 ◽

2020 ◽

Vol 8 (2) ◽

pp. 90

Author(s):

Sheena Henry ◽

Lu Shi ◽

Virginia Alexander ◽

Richard O’Neal ◽

Stephen Carey ◽

...

Keyword(s):

Group Intervention ◽

Internal Medicine Resident ◽

Mean Value ◽

T Test ◽

Post Intervention ◽

Medicine Resident ◽

Significant Difference ◽

One Year ◽

Paired T Test

We examined the impact of a group-based self-empowerment intervention among diabetes patients, which uses multidisciplinary education, collaborative learning, peer support, and development of diabetes-specific social capital to improve glycemic control and weight management. Thirty-five patients who had primary care established at the Prisma Health Upstate, Internal Medicine Resident clinic and held the diagnosis of diabetes for longer than one year were recruited for our single-arm pilot intervention. Each group intervention session involved one to two internal medicine resident physician facilitators, a clinical diabetic educator, and 5–10 patients. Each session had a framework facilitated by the resident, with most of the discussion being patient-led, aiming to provide a collaborative learning environment and create a support group atmosphere to encourage self-empowerment. Patients’ hemoglobin A1c level and body mass index (BMI) before the intervention and 3 to 6 months after completion were collected from the laboratory results obtained in the participants’ routine clinic visits. All graduates from this three-week intervention were invited to attend monthly maintenance sessions, and we tracked the HgbA1c measures of 29 JUMP graduates one year after the intervention, even though 13 of the 29 chose not to participate in the monthly maintenance sessions. The pre-intervention HgbA1c level averaged 8.84%, whereas the post-intervention HgbA1c level averaged 7.81%. A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007). For BMI, there was an average decline of 0.78 from the pre-intervention mean value of 40.56 to the post-intervention mean value of 39.78 (p = 0.03). Among the 29 participants who agreed to participate in our follow-up measure of their HgbA1c status one year after the intervention, a paired t test showed that there was no significant difference between the post-JUMP measure and the follow-up measure (p = 0.808). There was no statistically significant difference between the HgbA1c level of those participating in the maintenance program and that of those not participating (post-intervention t test of between-group difference: p = 0.271; follow-up t test of between-group difference: p = 0.457). Our single-arm, pilot study of the three-week group intervention of self-empowerment shows promising results in glycemic control and weight loss. The short duration and small number of sessions expected could make it more feasible for implementation and dissemination as compared with popular intervention protocols that require much longer periods of attendance, if the effectiveness of this patient group-based self-empowerment approach can be further established by randomized controlled studies in the future.

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Survival after radiation therapy for early-stage endometrial carcinoma: The Oslo study revisited after up to 43 years of follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5008 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5008-5008 ◽

Cited By ~ 4

Author(s):

Kristina Lindemann ◽

Mathias Onsrud ◽

Gunnar Kristensen ◽

Claes Trope

Keyword(s):

Endometrial Carcinoma ◽

Patient Group ◽

Early Stage ◽

Secondary Cancer ◽

External Radiation ◽

Pelvic Radiation ◽

Secondary Cancers ◽

Increased Risk ◽

Significant Difference

5008 Background: There is an ongoing debate regarding the benefit of radiation in patients with early stage endometrial carcinoma. Data on long time risk conferred by radiation is scarce. This study is a long-term follow-up on survival and secondary cancers of a previously published randomized study (Aalders J. et al., Obstet Gynecol 1980; 56: 419-27). Methods: Between 1968 and 1974, 568 patients with endometrial cancer FIGO stage I primarily treated with abdominal hysterectomy and bilateral salpingo-oophorectomy were included in the study. Patients were postoperatively randomized to receive either vaginal radium brachytherapy followed by external pelvic radiation 40 Gy (N=288) or brachytherapy alone (N=280). Survival data and data on incident secondary cancers were obtained by individual linkage to the Registry of Statistics Norway and Cancer Registry of Norway. By the end of follow-up at 1 November 2011, 45 (7.9%) patients were still alive. We used Cox proportional hazards model to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). We also conducted analyses stratified by age groups. Results: After median 21 (range 0-43.4) years of follow-up there was no significant difference in overall survival or relapse free survival between treatment arms with HR of 1.12 (95% CI: 0.95-1.33) and HR 0.88 (95% CI: 0.55-1.40), respectively. Patients treated with external radiation had significantly lower risk of developing locoregional relapse (p<0.001). However, women younger than 60 years had a significant poorer survival after external radiation (HR 1.36; 95% Cl: 1.06-1.76). In this patient group the risk of secondary cancer was significantly increased (HR 1.9; 95% CI: 1.23-3.03). Conclusions: We observed no survival benefit of external pelvic radiation in early stage endometrial carcinoma. In women younger than 60 years, pelvic radiation decreased survival, probably due to increased risk of subsequent second neoplasms. Adjuvant external radiotherapy cannot be recommended to this patient group. Those who have received such treatment might eventually benefit from prolonged post treatment surveillance with respect to secondary cancer.

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