Do PORTEC-3 and GOG-258 change your approach to managing patients with high-risk or node positive endometrial cancer?

The ambiguous answer is "yes and no." The positive impact of RT on vaginal and nodal failure rates cannot be ignored and argues for a continued role for RT, probably external RT.

There are a number of caveats relative to the interpretations of GOG 258. These include (but may not be limited to) high ineligibility rate (10%), incomplete staging data (at this point) with some stage discrepancies such has higher % of IIIC's in Chemo-RT arm, high percentage of patients on the Chemo-RT arm who did no...

Based on PORTEC 3, there is a limited benefit of chemo in high risk stage I and II disease (similar to GOG 249) and an improvement in outcome for stage III endometrioid disease (randomization was chemo RT vs. RT). GOG 258 for advanced stage shows a significant decrease in locoregional recurrence (28% vs. 13%), with chemo RT vs. chemo alone with a slight increase in distant mets (7% difference) when chemo RT was done before chemo. With 28% locoregional relapse with chemo alone, I would say my app...

We should await final publication of GOG 258, but the results unfortunately will be interpreted as a negative study for combined chemo+RT. This despite the significant locoregional benefit of radiation of 15%

It should be noted that while the study is described as having Stage III endometrial cancer(EC) patients , the majority were IIIC to which the results should apply and NOT be used in a blanket fashion for all stage III patients.

We have previously shown in a multi-institutional setting that P...