PORTEC-1 Study

Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multi-centre randomised trial

Disease site

uterus

Publication month/year

April 2000

Study question

To find whether postoperative pelvic radiotherapy improves locoregional control and survival for patients with stage-1 endometrial carcinoma

Type of study

Randomised controlled trial (RCT)

Interventions compared

Pelvic radiotherapy or No radiotherapy after hysterectomy & bilateral salpingoopherectomy (without lymphadenectmy)

Experimental arm (Intervention)

Pelvic radiotherapy (46 Gy) following surgery (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal washing without routine lymphadenectomy – biopsy from suspicious lymph nodes).

Control arm

No further treatment following surgery

Primary outcome

Locoregional recurrence and Death

Secondary outcome

Treatment-related morbidity and Survival after relapse

Inclusion criteria

Patients with post-operative histo-pathologically proven stage-1 endometrial carcinoma

  • Grade 1 with deep [≥50%] myometrial invasion
  • Grade 2 with any invasion
  • Grade 3 with superficial [<50%] invasion)
  • Any FIGO stage 1B and 1C (FIGO staging 1988)
Exclusion criteria
  • History of invasive cancer (except for basal cell carcinoma of the skin)
  • Previously received chemotherapy, hormonal therapy, or radiotherapy
  • WHO – performance score >2
Results
Radiotherapy No Radiotherapy
Randomised 354 361
Received treatment(n) 339 355
Locoregional relapse(n,%) 11(4.2%) 40(13.7%)
Distant metastasis(n,%) 18(6.4%) 13(4.5%)
Death(n, %) 57(19.3%) 48(14.9%)
Primary treatment complications(n,%) 84(25%) 22(6%)
  • Post-relapse survival rate @2 year / 3 years post-relapse was significantly higher in those with locoregional recurrence (79% / 69%) vs. those with distant metastasis (21% / 13%), p<0.001.
  • Patient< 60 years age had lower risk of locoregional recurrence (4% vs 10%, p=0.02) compared to patients >60 years old.
  • Patients <60 years old had a lower risk of death (4% vs 9%, p=0.02) when compared to those > 60 years old.
  • Lower grade of endometrial cancer associated with less distant metastasis and lower death rates. Grade 3 endometrial cancers had 14% risk of distant metastasis vs 1% in grade 1 and 5% in grade 2 cancers
  • Patients with high grade cancer had 16%  increased risk of death when compared to low grade cancer (p=0.0008).
Conclusions
  • The reduction of incidence of locoregional recurrence in the radiotherapy arm was not translated into a survival benefit
  • Distant metastasis was similar in both groups
  • Patients < 60 years (except with grade 3 tumours) have  significantly reduced rates of local recurrence and death
Study limitations
  • Not taken into consideration differences in surgical proficiency
  • Both groups had similar mean age but higher proportion of patients below 60 in the control group
  • Not taken into account the difference in the histological subtypes between the groups (more non-endometroid cancers in radiotherapy group)
Additional resources
Reviewer name

Emad S. Nasr