A 55-year-old woman with endometrial carcinoma FIGO Stage IIIC1 (positive pelvic lymph nodes, no para-aortic involvement) is planned for adjuvant therapy. The PORTEC-3 trial results recommend which treatment?
- A Concurrent chemoradiation (cisplatin-based during pelvic RT) followed by 4 cycles of carboplatin/paclitaxel, which improved recurrence-free and overall survival versus RT alone in high-risk endometrial cancer ✓
- B Pelvic radiotherapy alone (45 Gy) as lymph node dissection has already addressed nodal disease
- C 6 cycles of carboplatin/paclitaxel chemotherapy alone, avoiding radiation in stage IIIC1 with single node involvement
- D Progestogen hormonal therapy only, as Stage IIIC1 endometrioid tumours are hormone receptor-positive
Correct answer: A. Concurrent chemoradiation (cisplatin-based during pelvic RT) followed by 4 cycles of carboplatin/paclitaxel, which improved recurrence-free and overall survival versus RT alone in high-risk endometrial cancer
Explanation
PORTEC-3 (Lancet Oncology 2018, updated 2022) was a randomised Phase III trial comparing concurrent chemoradiotherapy (CRT: pelvic RT with 2 cycles of cisplatin, then 4 cycles of carboplatin/paclitaxel) versus pelvic RT alone in high-risk endometrial cancer (Stage I Grade 3 with myoinvasion, Stage II, Stage III, and serous/clear cell histology). CRT significantly improved 5-year recurrence-free survival (76% vs 69%) and overall survival in Stage III patients. Current ESMO and NCCN guidelines recommend CRT as standard of care for Stage IIIC1 endometrial carcinoma.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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