A subgroup of endometrial cancer patients with early-stage disease will progress or eventually present with recurrent disease. Multiple risk stratification strategies have been attempted to direct adjuvant therapeutic interventions. Radiation has been the most common form of adjuvant therapy offered to these patients. Unfortunately, its use has not translated into survival improvements. There is growing evidence supporting the use of adjuvant chemotherapy and multimodal interventions for patients with endometrial cancer. This review focuses on the role of adjuvant therapies for patients with early-stage disease with emphasis on future directions for risk stratification and personalized treatment.