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Changing trends in treatment of Stage I endometrial carcinoma are reflected in the modalities used in the University Hospital in Groningen. From 1969 to 1979, three treatment regimes have been used in 182 patients with Stage I disease: Group A (50 patients): preoperative uterine radium packing followed by surgery six weeks later; Group B (94 patients): preoperative low dose external irradiation (14 Gray) immediately followed by surgery and an additional 40 Gray in patients who had invasion of the myometrium beyond the inner one-third; Group C (38 patients): primary surgery with post-operative radiation therapy. No significant differences were found in the 5-year actuarial survivals of 92, 90 and 88% in Groups A, B and C respectively. Most recurrences were seen in Group B (16%) as compared to 10% in Group A and 8% in Group C. Poor prognostic factors were found to be myometrial infiltration beyond the inner one-third, dedifferentiation of the tumor (Grade 2 and 3), vascular invasion, age over 60 years, and uterine length over 8 cm. The advantages of primary surgery, allowing for accurate surgical-pathological examination and individualization of postoperative irradiation, are stressed.