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Br J Cancer. 2018 Oct;119(9):1067-1074. doi: 10.1038/s41416-018-0310-8. Epub 2018 Oct 25.

Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy.

Author information

1
Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
2
Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands.
5
Maastricht Radiation Oncology Clinic, Maastricht, The Netherlands.
6
Radiotherapy Group, Arnhem, The Netherlands.
7
Department of Radiation Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands.
8
Radiotherapy Institute Friesland, Leeuwarden, The Netherlands.
9
Radiotherapy Group, Deventer, The Netherlands.
10
Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands.
11
Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, The Netherlands.
12
Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
13
Department of Biostatistics, ErasmusMC Cancer Institute, Rotterdam, The Netherlands.
14
Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. r.a.nout@lumc.nl.

Abstract

BACKGROUND:

PORTEC-2 was a randomised trial for women with high-intermediate risk (HIR) endometrial cancer, comparing pelvic external beam radiotherapy (EBRT) with vaginal brachytherapy (VBT). We evaluated long-term outcomes combined with the results of pathology review and molecular analysis.

METHODS:

427 women with HIR endometrial cancer were randomised between 2002-2006 to VBT or EBRT. Primary endpoint was vaginal recurrence (VR). Pathology review was done in 97.4%, combined with molecular analysis.

RESULTS:

Median follow-up was 116 months; 10-year VR was 3.4% versus 2.4% for VBT vs. EBRT (p = 0.55). Ten-year pelvic recurrence (PR) was more frequent in the VBT group (6.3% vs. 0.9%, p = 0.004), mostly combined with distant metastases (DM). Ten-year isolated PR was 2.5% vs. 0.5%, p = 0.10, and DM 10.4 vs. 8.9% (p = 0.45). Overall survival for VBT vs. EBRT was 69.5% vs. 67.6% at 10 years (p = 0.72). L1CAM and p53-mutant expression and substantial lymph-vascular space invasion were risk factors for PR and DM. EBRT reduced PR in cases with these risk factors.

CONCLUSION:

Long-term results of the PORTEC-2 trial confirm VBT as standard adjuvant treatment for HIR endometrial cancer. Molecular risk assessment has the potential to guide adjuvant therapy. EBRT provided better pelvic control in patients with unfavourable risk factors.

PMID:
30356126
DOI:
10.1038/s41416-018-0310-8

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