Postoperative vaginal brachytherapy

Results of two randomized trials that used adjuvant radiation therapy in patients with stage I disease did not show improved survival but did show reduced locoregional recurrence (3%–4% in the radiation therapy group vs. 12%–14% in the control group after median follow-up of 5–6 years; P < .001), with an increase in side effects.[27,31,32][Level of evidence B1]

Results of a study by the Danish Endometrial Cancer Group suggest that the absence of radiation therapy does not improve the survival of patients with stage I intermediate-risk disease (grades 1 and 2 with >50% myometrial invasion or grade 3 with <50% myometrial invasion).[33]

The PORTEC-2 trial (NCT00411138) randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo VBT or EBRT, with prevention of vaginal recurrence as the primary outcome.[29,34][Level of evidence A1]

The PORTEC-2 trial (NCT00411138) randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo VBT or EBRT, with prevention of vaginal recurrence as the primary outcome.[29,34][Level of evidence A1]

At 5 years, there was no difference in the rates of vaginal recurrence, locoregional recurrence, PFS, or OS (84.8% [95% confidence interval (CI), 79.3%–90.3%] for VBT vs. 79.6% [95% CI, 71.2%–88.0%] for EBRT; P = .57).

The PORTEC-2 trial (NCT00411138) randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo VBT or EBRT, with prevention of vaginal recurrence as the primary outcome.[29,34][Level of evidence A1]

The VBT group had significantly fewer gastrointestinal toxic effects and improved quality of life, making VBT the preferred option for adjuvant treatment of patients with stage I disease.

The Norwegian Radium Hospital trial included 568 patients with clinical stage I endometrial cancer between 1968 and 1974 (before FIGO surgical staging was initiated).[30][Level of evidence A1] After hysterectomy and bilateral salpingo-oophorectomy, patients were randomly assigned to receive either EBRT and VBT or VBT alone.

The Norwegian Radium Hospital trial included 568 patients with clinical stage I endometrial cancer between 1968 and 1974 (before FIGO surgical staging was initiated).[30][Level of evidence A1] After hysterectomy and bilateral salpingo-oophorectomy, patients were randomly assigned to receive either EBRT and VBT or VBT alone.

An updated report presenting over 20 years of follow-up data showed no difference in OS between the treatment groups. Median OS was 20.5 years in the EBRT/VBT group and 20.48 years in the VBT-alone group (P = .186). In all women, there was an increased risk of secondary cancers after EBRT (hazard ratio [HR], 1.42; 95% CI, 1.01–2.0).

The Norwegian Radium Hospital trial included 568 patients with clinical stage I endometrial cancer between 1968 and 1974 (before FIGO surgical staging was initiated).[30][Level of evidence A1] After hysterectomy and bilateral salpingo-oophorectomy, patients were randomly assigned to receive either EBRT and VBT or VBT alone.

A post hoc subset analysis of women younger than 60 years at the time of trial registration showed increased mortality in the EBRT/VBT arm (HR, 1.36; 95% CI, 1.06–1.76). Further, the risk of secondary cancers doubled in this group (HR, 2.02; 95% CI, 1.3–3.15).