Ahmed Hamed: Breaking Down Landmark Trials in Endometrial Cancer
Ahmed Hamed, Radiation Oncologist, Medical Director in Egyptian Cancer Center, shared a post on LinkedIn:
“Endometrial cancer is one of my favorite topics to discuss with junior colleagues. Trial names are easy to remember, thus their impact on SOC is also well memorized.
ASTEC trial
A Study of Treatment in Endometrial Cancer.
Aim: investigating the role of lymphadenectomy in clinically node negative operable endometrial cancer.
Result: Lymphadenectomy improves staging but doesn’t impact survival.
SOC: Lymphadenectomy is only for cN+ patients by pre-op imaging.
PORTEC 1 trial.
PORT in EC.
Aim: In light of GOG 33 and GOG 99 trials, PORTEC 1 trial was aiming at further fine-tuning of PORT in early stage endometriod EC patients at risk of locoregional relapse + reducing radiation dose to 45Gy rather than 50.4Gy to to avoid the notorious A/E associated with pelvic RTH.
Result: To simplify, pts with 2 or more risk factors are in need for PORT. (Age >60 // Grade 3 histology) LVSI was identified later via the pooled analysis of PORTEC 1,2 trials.
Side Finding: 75% of relapses were at the vaginal vault.
PORTEC 2 trial
Aim: If 75% of relapses are at the vaginal cuff (VC), can VC brachytherapy replace EBRT?
Result: VCBT is non-inferior to EBRT in reducing VC recurrence (not pelvic nodal recurrence) and less toxic.
Recent updates: Molecular study of PORTEC 1,2,3 trials patients were able to identify 4 distint -clinically significant- molecular subgroups
1. POLE mutation.
2. MSI high / dMMR.
3. NSMP.
4. P53 mutation.
The difference between these 4 and clinical significance is as follows: ”
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