Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 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

B G Wortman  1 , C L Creutzberg  1 , H Putter  2 , I M Jürgenliemk-Schulz  3 , J J Jobsen  4 , L C H W Lutgens  5 , E M van der Steen-Banasik  6 , J W M Mens  7 , A Slot  8 , M C Stenfert Kroese  9 , B van Triest  10 , H W Nijman  11 , E Stelloo  12 , T Bosse  12 , S M de Boer  1 , W L J van Putten  13 , V T H B M Smit  12 , R A Nout  14 ; PORTEC Study Group
Affiliations
Randomized Controlled Trial

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

B G Wortman et al. Br J Cancer. 2018 Oct.

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consort diagram of the PORTEC-2 trial with pathology review
Fig. 2
Fig. 2
Ten year results of the PORTEC-2 trial
Fig. 3
Fig. 3
a Endometrial cancer-related survival by 4 molecular subgroups. b Total pelvic recurrence by unfavourable risk factors (LVSI, p53-mutant or L1CAM expression)
See this image and copyright information in PMC

Comment in

References

    1. Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387:1094–1108. doi: 10.1016/S0140-6736(15)00130-0. - DOI - PubMed
    1. Creutzberg CL, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post operative radiation therapy in endometrial carcinoma. Lancet. 2000;355:1404–1411. doi: 10.1016/S0140-6736(00)02139-5. - DOI - PubMed
    1. Creutzberg CL, et al. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 2011;81:631–638. doi: 10.1016/j.ijrobp.2011.04.013. - DOI - PubMed
    1. Keys HM, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol. Oncol. 2004;92:744–751. doi: 10.1016/j.ygyno.2003.11.048. - DOI - PubMed
    1. Blake P, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373:137–146. doi: 10.1016/S0140-6736(08)61767-5. - DOI - PMC - PubMed

Publication types

Substances