For early stage endometrial cancer, surgery is the cornerstone of treatment. For these patients, brachytherapy or external radiation therapy is advocated by some as the optimal adjuvant treatment. However, several studies concluded that adjunctive radiation therapy in early-stage, intermediate-risk endometrial carcinoma decreased the risk of local recurrence but had a questionable role in preventing tumor spread, and that distant metastases remained a significant cause of failure in these patients.