A 65-year-old woman with FIGO Stage IB Grade 2 endometrioid endometrial carcinoma (myometrial invasion greater than 50 percent, no LVSI) undergoes total hysterectomy and BSO. Based on the PORTEC-2 trial, which adjuvant treatment is most appropriate to reduce vaginal vault recurrence while minimizing toxicity?

• A Pelvic external beam radiotherapy
• B Adjuvant chemotherapy alone
• C Combined chemoradiation
• D Vaginal brachytherapy ✓

Explanation

The PORTEC-2 trial demonstrated that vaginal brachytherapy is as effective as pelvic external beam radiotherapy in preventing vaginal recurrence for high-intermediate risk endometrial cancer, with significantly less gastrointestinal toxicity. Pelvic EBRT is reserved for patients with higher risk factors like Stage II or Grade 3 with LVSI. Chemotherapy is typically used for Stage III or serous histologies.

Reference: Bailey and Love Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.