This document summarizes the results of the PORTEC-3 trial which compared adjuvant chemoradiation therapy (CTRT) to radiation alone in patients with high risk endometrial cancer. The trial included patients with high risk factors like grade 3 endometrioid cancer, stage II-III disease, or clear cell or serous histology. It found that while CTRT improved failure-free survival by 11% compared to radiation alone, there was only a 5% improvement in overall survival. CTRT was also associated with more toxicities but they were generally rapid to recover from. The benefits of CTRT need to be weighed against the increased costs and treatment duration associated with its toxicities. The conclusion

1. ADJUVANT CHEMORADIATIONTHERAPY vs
RADIATION ALONE IN HIGH RISK
ENDOMETRIAL CANCER: PORTEC TRIAL -3
DR MEBANSHANBOR GAROD
(MS GENERAL SURGERY, FMAS,
FEBS SURGICAL ONCOLOGY)
SURGICAL ONCOLOGY DEPT.,
NEIGRIHMS, SHILLONG

2. FIGO Staging

14. Methods: open label, randomised trial.

15. Inclusion Criteria:
 High risk endometrial CA FIGO I
Endometroid type Grade 3 ;with deep endometrial invasion or LVSI
 Endometroid type stage II or III
 Clear or Serous types Stage I-III
 Parametrial invovlement

16. Exclusion Criteria:
 Uterine sarcoma/carcinosarcoma
 Prior endometrial Ca
 Previous pelvic RT/HRT/CT
 Bulky cervical involvement
 IBD
 Residual macroscopic tumor
 Impaired renal / cardiac function
 => grade 2 neuropathy

17. Patients Stratification:

20. Outcomes

22. Adverse Effects: CTCAE grading

24. Merits:
 Multicentric trial with strong international collaboration (six groups) : highly
representative of current world wide practice
 The primary endpoints were overall survival and failure free survival.
 The funding bodies had no role in the study design ;data collection,
interpratation, analysis, or writing of report
 Central pathology review was dine by reference gynaecopathologists
 Toxicity assessed by independent comittee using CTCAE

25. Limitations:
 Surgical staging varies
 Radiation dosage and types of radiation modalities not uniform
 Final outcomes / analysis were time based rather than events base; long
term outcomes needs to be analysed.
 Costs of CTRT in terms of toxicity and treatment duration needs to be
weighed against benefits

26. Conclusion:
 CTRT no overall survival benefit (5% );
5 year failure free survival 11% improvement
 Toxicities more in CTRT group: rapid recovery
 Response better in endometroid type: serous and clear cell types
associated with poorer prognosis

27. Summary
Risk groups for adjuvant Treatment:
 Low Risk : Endometroid IA, G-1/G2
NAT
 Low Intermediate Risk: Endometroid IB ; IC G1/G2
LND-> NAT, No LND->VBT
 High intermediate risk: stage IIA, IC or G3; LVI; >60 yrs,
LND-> VBT , No LND->EBRT
 High Risk Group: endometroi IC & G3; II B;serous or clear cell
EBRT , ? CTRT

28. Thank you...