In the PORTEC-2 trial, women with high-intermediate risk endometrial carcinoma were randomised between pelvic external beam radiotherapy and vaginal brachytherapy. Which conclusion was demonstrated?

• A External beam radiotherapy reduced distant metastases compared with brachytherapy
• B Chemotherapy added to brachytherapy improved survival
• C Vaginal brachytherapy gave equivalent vaginal recurrence control with fewer gastrointestinal toxicities ✓
• D Neither modality altered vaginal recurrence rates compared with observation

Explanation

PORTEC-2 established that vaginal brachytherapy is non-inferior to external beam radiotherapy for preventing vaginal recurrence in high-intermediate risk patients after surgery, with significantly less acute and late gastrointestinal toxicity. External beam therapy offers no advantage in distant control in this population, and neither arm addressed systemic therapy. This trial underpins the modern preference for vault brachytherapy alone in high-intermediate risk disease.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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