***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This study was undertaken to prospect ively evaluate the effect of early stage endometrial cancer , age , and obesity on quality of life ( QOL ) . STUDY DESIGN Women undergoing surgery for endometrial cancer or an adnexal mass determined at surgery to be benign ( controls ) were enrolled preoperatively and followed for 6 months . RESULTS Seventy-nine women completed the study .  Functional Assessment of Cancer Therapy ( FACT-G ) scores increased significantly in all women ; however , significant differences by patient weight and age were obtained . Obesity was associated with decreased physical FACT-G and SF-36 scores . Older women had lower SF-36 physical scores , higher emotional scores , and less change over time . CONCLUSION Women with early endometrial cancer had similar changes in QOL as those who received surgery for benign disease . Obese and elderly women had domain alterations . Given the aging population and rising incidence of obesity , these results emphasize the need for QOL interventions in postoperative gynecologic care of these patients BACKGROUND About 15 % of patients with endometrial cancer have high-risk features and are at increased risk of distant metastases and endometrial cancer-related death . We design ed the PORTEC-3 trial to investigate the benefit of adjuvant chemoradiotherapy compared with radiotherapy alone for women with high-risk endometrial cancer . METHODS PORTEC-3 was a multicentre , open-label , r and omised , international trial . Women with high-risk endometrial cancer were r and omly allocated ( 1:1 ) to radiotherapy alone ( 48·6 Gy ) in 1·8 Gy fractions five times a week or chemoradiotherapy ( two cycles concurrent cisplatin 50 mg/m(2 ) and four adjuvant cycles of carboplatin area under the curve [ AUC ] 5 and paclitaxel 175 mg/m(2 ) ) using a biased coin minimisation procedure with stratification for participating centre , lymphadenectomy , stage of cancer , and histological type . The primary endpoints of the PORTEC-3 trial were overall survival and failure-free survival analysed in the intention-to-treat population . This analysis focuses on 2-year toxicity and health-related quality of life as secondary endpoints ; analysis was done according to treatment received . Health-related quality of life was assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Question naire Core 30 ( EORTC QLQ-C30 ) the cervix cancer module and chemotherapy and neuropathy subscales of the ovarian cancer module at baseline , after radiotherapy and at 6 , 12 , 24 , 36 , and 60 months after r and omisation . Adverse events were grade d with Common Terminology Criteria for Adverse Events version 3.0 . The study was closed on Dec 20 , 2013 , after achieving complete accrual , and follow-up remains ongoing for the primary outcomes analysis . This trial is registered with IS RCT N.com , number IS RCT N14387080 , and with Clinical Trials.gov , number NCT00411138 . FINDINGS Between Sept 15 , 2006 , and Dec 20 , 2013 , 686 women were r and omly allocated in the PORTEC-3 trial . Of these , 660 met eligibility criteria , and 570 ( 86 % ) were evaluable for health-related quality of life . Median follow-up was 42·3 months ( IQR 25·8 - 55·1 ) . At completion of radiotherapy and at 6 months , EORTC QLQ-C30 functioning scales were significantly lower ( worse functioning ) and health-related quality of life symptom scores higher ( worse symptoms ) for the chemoradiotherapy group compared with radiotherapy alone , improving with time . At 12 and 24 months , global health or quality of life was similar between groups , whereas physical functioning scores remained slightly lower in patients who received chemoradiotherapy compared with patients who received radiotherapy alone . At 24 months , 48 ( 25 % ) of 194 patients in the chemoradiotherapy group reported severe tingling or numbness compared with 11 ( 6 % ) of 170 patients in the radiotherapy alone group ( p<0·0001 ) . Grade 2 or worse adverse events were found during treatment in 309 ( 94 % ) of 327 patients in the chemoradiotherapy group versus 145 ( 44 % ) of 326 patients in the radiotherapy alone group , and grade 3 or worse events were found in 198 ( 61 % ) of 327 patients in the chemoradiotherapy group versus 42 ( 13 % ) of 326 patients in the radiotherapy alone group ( p<0·0001 ) , with most of the grade 3 adverse events being haematological ( 45 % ) . At 12 and 24 months , no significant differences in grade 3 or worse adverse events were found between groups ; only grade 2 or higher sensory neuropathy adverse events persisted at 24 months ( 25 [ 10 % ] of 240 patients in the chemoradiotherapy group vs one [ < 1 % ] of 247 patients in the radiotherapy alone group ; p<0·0001 ) . INTERPRETATION Despite the increased physician and patient-reported toxicities , this schedule of adjuvant chemotherapy given during and after radiotherapy in patients with high-risk endometrial cancer is feasible , with rapid recovery after treatment , but with persistence of patient-reported sensory neurological symptoms in 25 % of patients . We await the analysis of primary endpoints before final conclusions are made . FUNDING Dutch Cancer Society , Cancer Research UK , National Health and Medical Research Council , Project Grant , Cancer Australia Grant , Italian Medicines Agency , and Canadian Cancer Society Research Institute Objectives Laparoscopic hysterectomy ( LH ) is increasingly used for the management of endometrial malignancy . Its benefits may be particularly pronounced as these women are more likely to be older or obese . The aim of this study was to determine whether outcomes for LH are comparable to the open hysterectomy ( OH ) . Design This was a prospect i ve cohort study nested within the multicenter ASTEC ( A Study in the Treatment of Endometrial Cancer ) r and omized controlled trial ( 1998–2005 ) . Population Women with presumed early endometrial cancer were included . Methods Laparoscopic hysterectomy was compared with OH with or without systematic lymphadenectomy . Main Outcome Measures Overall survival , time to first recurrence , complication rates , and surgical outcomes were the main outcome measures . Results Of 1408 women , 1309 ( 93 % ) received OH , and 99 ( 7 % ) had LH . LH was associated with longer operating time ( median , LH 105 minutes [ interquartile range ( IQR ) , 60–150 ] vs OH 80 minutes [ IQR , 60–95 ] ; P < 0.001 ) but 50 % shorter hospital stay ( median , LH 4 days [ IQR , 3–5 ] vs OH 6 days [ IQR , 5–7 ] ) . The number of harvested lymph nodes was similar ( median , LH 13 [ IQR , 10–16 ] vs OH 12 [ IQR , 11–13 ] ; P = 0.67 ) . LH had fewer intraoperative and postoperative adverse events ( 9 % difference , LH 21 % vs OH 30 % ; borderline significance ; P = 0.07 ) . The rate of conversion to laparotomy for the LH group was high ( 27 % ) . The median follow-up was 37 months . After adjusting for significant prognostic factors , the hazard ratio for overall survival in those who underwent LH compared with those who underwent OH was 0.67 ( 95 % confidence interval , 0.31–1.43 ) ( P = 0.30 ) . Conclusions Laparoscopic hysterectomy for early endometrial cancer is safe . Although it requires longer operating time it is associated with shorter hospital stay and favorable morbidity profile . Further studies are required to assess the long-term safety CONTEXT The Heart and Estrogen/progestin Replacement Study ( HERS ) found no overall reduction in risk of coronary heart disease ( CHD ) events among postmenopausal women with CHD . However , in the hormone group , findings did suggest a higher risk of CHD events during the first year , and a decreased risk during years 3 to 5 . OBJECTIVE To determine if the risk reduction observed in the later years of HERS persisted and result ed in an overall reduced risk of CHD events with additional years of follow-up . DESIGN AND SETTING R and omized , blinded , placebo-controlled trial of 4.1 years ' duration ( HERS ) and subsequent unblinded follow-up for 2.7 years ( HERS II ) conducted at outpatient and community setting s at 20 US clinical centers . PARTICIPANTS A total of 2763 postmenopausal women with CHD and average age of 67 years at enrollment in HERS ; 2321 women ( 93 % of those surviving ) consented to follow-up in HERS II . INTERVENTION Participants were r and omly assigned to receive 0.625 mg/d of conjugated estrogens and 2.5 mg of medroxyprogesterone acetate ( n = 1380 ) , or placebo ( n = 1383 ) during HERS ; open-label hormone therapy was prescribed at personal physicians ' discretion during HERS II . The proportions with at least 80 % adherence to hormones declined from 81 % ( year 1 ) to 45 % ( year 6 ) in the hormone group , and increased from 0 % ( year 1 ) to 8 % ( year 6 ) in the placebo group . MAIN OUTCOME MEASURES The primary outcome was nonfatal myocardial infa rct ion and CHD death . Secondary cardiovascular events were coronary revascularization , hospitalization for unstable angina or congestive heart failure , nonfatal ventricular arrhythmia , sudden death , stroke or transient ischemic attack , and peripheral arterial disease . RESULTS There were no significant decreases in rates of primary CHD events or secondary cardiovascular events among women assigned to the hormone group compared with the placebo group in HERS , HERS II , or overall . The unadjusted relative hazard ( RH ) for CHD events in HERS was 0.99 ( 95 % confidence interval [ CI ] , 0.81 - 1.22 ) ; HERS II , 1.00 ( 95 % CI , 0.77 - 1.29 ) ; and overall , 0.99 ( 0.84 - 1.17 ) . The overall RHs were similar after adjustment for potential confounders and differential use of statins between treatment groups ( RH , 0.97 ; 95 % CI , 0.82 - 1.14 ) , and in analyses restricted to women who were adherent to r and omized treatment assignment ( RH , 0.96 ; 95 % CI , 0.77 - 1.19 ) . CONCLUSIONS Lower rates of CHD events among women in the hormone group in the final years of HERS did not persist during additional years of follow-up . After 6.8 years , hormone therapy did not reduce risk of cardiovascular events in women with CHD . Postmenopausal hormone therapy should not be used to reduce risk for CHD events in women with CHD BACKGROUND Postmenopausal oestrogen therapy reduces the risk of osteoporosis and cardiovascular diseases but is associated with an increased risk of endometrial cancer . We have assessed the impact of a regimen of oestrogen with cyclic progestagen on risk of endometrial cancer for postmenopausal women . METHODS We did a population -based case-control study of women aged 45 - 74 years in western Washington State , USA . Cases were identified from a regional cancer registry as having histologically confirmed endometrial cancer during 1985 - 91 . 832 ( 72 % ) of 1154 eligible cases completed interviews . Controls were identified by r and om digit dialling , screened for intact uterus , frequency matched for age and county , and r and omly assigned a reference date within 1985 - 91 . Interviews with 1114 ( 73 % ) of 1526 eligible controls were done . The women provided information about use of hormone replacement therapy , and reproductive and medical history before diagnosis date ( cases ) or reference date ( controls ) . FINDINGS Relative to women who had never used hormones ( for > 6 months ) , women who had taken unopposed oestrogen had a four-fold increase ( 95 % CI 3.1 - 5.1 ) in risk of endometrial cancer . Women who used a combined therapy of oestrogen with cyclic progestagen ( eg . medroxyprogesterone acetate ) had a relative risk of 14 ( 1.0 - 1.9 ) . Among women with fewer than 10 days of added progestagen per month , the relative risk was 3.1 ( 1.7 - 5.7 ) . Whereas that for women with 10 - 21 days of added progestagen was 1.3 ( 0.8 - 2.2 ) . The use of these combined regimens for 5 or more years was associated with risks of 3.7 ( 1.7 - 8.2 ) and 2.5 ( 1.1 - 5.5 ) , respectively , relative to non- 
    Output:
    
However , there is a theoretical risk of promoting residual tumour cell growth and increasing cancer recurrence .
Therefore , this is a potential survival disadvantage in a woman who has a potentially curable cancer .
In premenopausal women with endometrial cancer , treatment induces early menopause and this may adversely affect overall survival .
Additionally , most women with early-stage disease will be cured of their cancer , making longer-term quality of life ( QoL ) issues more pertinent .
Currently , there is insufficient high- quality evidence to inform women considering HRT after treatment for endometrial cancer .
The available evidence ( both the single RCT and non-r and omised evidence ) does not suggest significant harm , if HRT is used after surgical treatment for early-stage endometrial cancer .