Vaginal Brachytherapy Versus External Beam Pelvic Radiotherapy For High-Intermediate Risk Endometrial Cancer - Randomised PORTEC-2 Trial

Main Category: Cancer / Oncology
Also Included In: Clinical Trials / Drug Trials;  Radiology / Nuclear Medicine
Article Date: 22 Sep 2008 - 3:00 PDT

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Endometrial carcinoma is the most common gynecological malignancy among postmenopausal European women. Patients with high-intermediate risk endometrial cancer (based on age, tumour stage and grade) who receive no further treatment following surgery, have an approximately 20% risk of developing a locoregional recurrence, of which 75% are located in the vagina and 25% in the pelvic lymph nodes. Postoperative pelvic external beam radiotherapy (EBRT) significantly reduces the rate of locoregional recurrence to 5% at five years.

The multicentre randomised PORTEC-2 trial was initiated to investigate if vaginal brachytherapy (VBT) would be equally effective in reducing the risk of locoregional recurrence, while at the same time reducing treatment related toxicity and improving HRQL.

Between 2002-2006, 427 patients were randomised (214 to EBRT and 213 to VBT). With a median follow-up of 36 months, the vaginal recurrence rates were not significantly different between the two arms (0.9% for VBT vs. 1.9% for EBRT, p=0.97), showing that VBT is very effective in preventing vaginal recurrence. In addition, locoregional recurrence rates (4.0% for VBT vs. 2.5% for EBRT p=0.15), overall survival and relapse-free survival rates (both 90%), were not significantly different between both treatment arms.

While the efficacy of the two treatments was similar, quality of life was better after VBT. Patients receiving VBT after surgery reported significantly and clinically relevant lower levels of diarrhoea (p<0.001), which resulted in significantly less limitations in daily activities (p<0.001) and significantly better social functioning (p<0.002).

As patient reported quality of life after VBT was shown to be better than after EBRT and efficacy of both treatments was similar, VBT should be the treatment of choice for patients with high-intermediate risk endometrial carcinoma.

Nout Remi et al. LUMC, Leiden, Netherlands

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ESTRO 27 (September 14th to 18th, 2008) offered an outstanding scientific programme combining lectures from eminent invited speakers, proffered papers and poster discussions, teaching lectures on a wide range of topics including clinical issues, brachytherapy, radiobiology, physics and technology as well as debates on controversial topics and clinical case discussions, a special poster reception, poster discussion sessions and electronic poster viewing.

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