A 52-year-old woman with endometrial cancer, Grade 1 endometrioid, Stage IA (no myometrial invasion, FIGO 2009), is treated with total hysterectomy and bilateral salpingo-oophorectomy. She asks about adjuvant treatment. According to PORTEC-1 trial findings, which adjuvant treatment is recommended?

• A External beam pelvic radiotherapy (EBRT) to reduce local recurrence
• B Observation only — adjuvant radiotherapy does not improve overall survival in Stage IA G1 and adds toxicity ✓
• C Vaginal vault brachytherapy to reduce vaginal vault recurrence
• D Chemotherapy (carboplatin-paclitaxel) for 6 cycles as standard

Explanation

The PORTEC-1 trial demonstrated that while adjuvant external beam pelvic radiotherapy reduced locoregional recurrence in low-intermediate risk endometrial cancer, it did not improve overall survival and significantly increased treatment toxicity (bowel, urinary complications). For Stage IA Grade 1 endometrioid carcinoma, the risk of recurrence is very low (< 5%), and observation alone is the current recommendation. PORTEC-2 subsequently showed vaginal brachytherapy equivalent to EBRT with less toxicity for intermediate-risk cases, not Stage IA G1.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.