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

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. METHO...

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Autores principales: Wortman, B. G., Creutzberg, C. L., Putter, H., Jürgenliemk-Schulz, I. M., Jobsen, J. J., Lutgens, L. C. H. W., van der Steen-Banasik, E. M., Mens, J. W. M., Slot, A., Kroese, M. C. Stenfert, van Triest, B., Nijman, H. W., Stelloo, E., Bosse, T., de Boer, S. M., van Putten, W. L. J., Smit, V. T. H. B. M, Nout, R. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219495/
https://www.ncbi.nlm.nih.gov/pubmed/30356126
http://dx.doi.org/10.1038/s41416-018-0310-8
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author Wortman, B. G.
Creutzberg, C. L.
Putter, H.
Jürgenliemk-Schulz, I. M.
Jobsen, J. J.
Lutgens, L. C. H. W.
van der Steen-Banasik, E. M.
Mens, J. W. M.
Slot, A.
Kroese, M. C. Stenfert
van Triest, B.
Nijman, H. W.
Stelloo, E.
Bosse, T.
de Boer, S. M.
van Putten, W. L. J.
Smit, V. T. H. B. M
Nout, R. A.
author_facet Wortman, B. G.
Creutzberg, C. L.
Putter, H.
Jürgenliemk-Schulz, I. M.
Jobsen, J. J.
Lutgens, L. C. H. W.
van der Steen-Banasik, E. M.
Mens, J. W. M.
Slot, A.
Kroese, M. C. Stenfert
van Triest, B.
Nijman, H. W.
Stelloo, E.
Bosse, T.
de Boer, S. M.
van Putten, W. L. J.
Smit, V. T. H. B. M
Nout, R. A.
author_sort Wortman, B. G.
collection PubMed
description 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.
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spelling pubmed-62194952020-01-16 Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy Wortman, B. G. Creutzberg, C. L. Putter, H. Jürgenliemk-Schulz, I. M. Jobsen, J. J. Lutgens, L. C. H. W. van der Steen-Banasik, E. M. Mens, J. W. M. Slot, A. Kroese, M. C. Stenfert van Triest, B. Nijman, H. W. Stelloo, E. Bosse, T. de Boer, S. M. van Putten, W. L. J. Smit, V. T. H. B. M Nout, R. A. Br J Cancer Article 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. Nature Publishing Group UK 2018-10-25 2018-10-30 /pmc/articles/PMC6219495/ /pubmed/30356126 http://dx.doi.org/10.1038/s41416-018-0310-8 Text en © The Author(s) 2018 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Wortman, B. G.
Creutzberg, C. L.
Putter, H.
Jürgenliemk-Schulz, I. M.
Jobsen, J. J.
Lutgens, L. C. H. W.
van der Steen-Banasik, E. M.
Mens, J. W. M.
Slot, A.
Kroese, M. C. Stenfert
van Triest, B.
Nijman, H. W.
Stelloo, E.
Bosse, T.
de Boer, S. M.
van Putten, W. L. J.
Smit, V. T. H. B. M
Nout, R. A.
Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
title Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
title_full Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
title_fullStr Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
title_full_unstemmed Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
title_short Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
title_sort ten-year results of the portec-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219495/
https://www.ncbi.nlm.nih.gov/pubmed/30356126
http://dx.doi.org/10.1038/s41416-018-0310-8
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