Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial

Author:

Nout Remi A.1,van de Poll-Franse Lonneke V.1,Lybeert Marnix L.M.1,Wárlám-Rodenhuis Carla C.1,Jobsen Jan J.1,Mens Jan Willem M.1,Lutgens Ludy C.H.W.1,Pras Betty1,van Putten Wim L.J.1,Creutzberg Carien L.1

Affiliation:

1. From the Leiden University Medical Center, Leiden; Comprehensive Cancer Centre South; Catharina Hospital, Eindhoven; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilberg; University Medical Center Utrecht, Utrecht; Medisch Spectrum Twente, Enschede; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam; MAASTtricht Radiation Oncology Clinic, Maastricht; and University Medical Center Groningen, Groningen, the Netherlands.

Abstract

PurposeTo determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial.Patients and MethodsBetween 1990 and 1997, 714 patients with stage IC grade 1 to 2 or IB grade 2 to 3 EC were randomly allocated to pelvic external-beam radiotherapy (EBRT) or no additional treatment (NAT). HRQL was evaluated with the Short Form 36-Item (SF-36) questionnaire; subscales from the European Organisation for Research and Treatment of Cancer (EORTC) PR25 module for bowel and bladder symptoms and the OV28 and CX24 modules for sexual symptoms; and demographic questions. Analysis was by intention-to-treat.ResultsMedian follow-up was 13.3 years. The 15-year actuarial locoregional recurrence rates were 5.8% for EBRT versus 15.5% for NAT (P < .001), and 15-year overall survival was 52% versus 60% (P = .14). Of the 351 patients confirmed to be alive with correct address, 246 (70%) returned the questionnaire. Patients treated with EBRT reported significant (P < .01) and clinically relevant higher rates of urinary incontinence, diarrhea, and fecal leakage leading to more limitations in daily activities. Increased symptoms were reflected by the frequent use of incontinence materials after EBRT (day and night use, 42.9% v 15.2% for NAT; P < .001). Patients treated with EBRT reported lower scores on the SF-36 scales “physical functioning” (P = .004) and “role-physical” (P = .003).ConclusionEBRT for endometrial cancer is associated with long-term urinary and bowel symptoms and lower physical and role-physical functioning, even 15 years after treatment. Despite its efficacy in reducing locoregional recurrence, EBRT should be avoided in patients with low- and intermediate-risk EC.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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