The PORTEC-2 trial compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) in intermediate-risk endometrial carcinoma. What was the primary finding?

• A VBT provided equivalent vaginal relapse control with less gastrointestinal toxicity than EBRT ✓
• B EBRT was superior to VBT for local control and overall survival
• C VBT reduced pelvic relapse rates while EBRT only prevented vaginal recurrence
• D Observation without adjuvant radiotherapy was equivalent to VBT in intermediate-risk disease

Explanation

PORTEC-2 (Nout et al., Lancet 2010) randomized intermediate-high risk endometrial carcinoma patients (Stage I–IIA) to EBRT vs VBT. VBT achieved equivalent vaginal relapse control (1.8% vs 1.6% at 5 years) and identical overall survival, but with significantly lower rates of gastrointestinal toxicity (13.8% vs 53.8% grade 1–2 GI symptoms). This established VBT as the preferred adjuvant therapy for intermediate-risk endometrial carcinoma, replacing EBRT for vaginal vault protection.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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