Originally published as JCO Early Release 10.1200/JCO.2008.20.2424 on June 22 2009

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Quality of Life After Pelvic Radiotherapy or Vaginal Brachytherapy for Endometrial Cancer: First Results of the Randomized PORTEC-2 Trial

From the Departments of Clinical Oncology and of Medical Statistics and Pathology, Leiden University Medical Center; and IKW Datacenter, Leiden; Department of Radiation Oncology, University Medical Center Utrecht; Department of Radiotherapy, Medisch Spectrum Twente, Enschede; Maastricht Radiation Oncology Clinic, Maastricht; Arnhem Radiotherapy Institute, Arnhem; Department of Radiation Oncology, ErasmusMC-Daniel den Hoed Cancer Center, Rotterdam; Radiotherapy Institute Friesland, Leeuwarden; Radiotherapy Institute Stedendriehoek en Omstreken, Deventer; Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam; and Department of Gynecology, University Medical Center Groningen, the Netherlands.

Corresponding author: Remi A. Nout, MD, Department of Clinical Oncology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: r.a.nout{at}lumc.nl.

Purpose Studies on quality of life (QOL) among women with endometrial cancer have shown that patients who undergo pelvic radiotherapy report lower role functioning and more diarrhea and fatigue. In the Post Operative Radiation Therapy in Endometrial Cancer (PORTEC) trial, patients with endometrial carcinoma were randomly assigned to receive external-beam radiotherapy (EBRT) or vaginal brachytherapy (VBT). QOL was evaluated by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and subscales from the prostate cancer module, PR-25, and the ovarian cancer module, OV-28.

Patients and Methods PORTEC-2 accrued 427 patients between 2002 and 2006, of whom 214 were randomly assigned to EBRT, and 213 were randomly assigned to VBT. Three-hundred forty-eight patients (81%) were evaluable for QOL. QOL outcomes were analyzed at a median follow-up of 2 years.

Results At baseline after surgery, patient functioning was at the lowest level, and it increased during and after radiotherapy to reach a plateau after 12 months. Patients in the VBT group reported better social functioning (P < .002) and lower symptom scores for diarrhea, fecal leakage, the need to stay close to the toilet, and limitation in daily activities because of bowel symptoms (P < .001). At baseline, 15% of patients were sexually active; this increased significantly to 39% during the first year (P < .001). Sexual functioning and symptoms did not differ between the treatment groups.

Conclusion Patients who received EBRT reported significantly higher levels of diarrhea and bowel symptoms. This resulted in a higher need to remain close to a toilet and, as a consequence, more limitation of daily activities because of bowel symptoms and decreased social functioning. Vaginal brachytherapy provides a better QOL, and should be the preferred treatment from a QOL perspective.

Written on behalf of the PORTEC-2 Study Group.

Supported by research Grant No. CKTO 2001-04 of the Dutch Cancer Society.

Presented in part at the 14th Biennial European Cancer Conference, September 23-27, 2007, Barcelona, Spain.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical Trials repository link available on JCO.org.

Clinical trial information can be found for the following: ISRCTN16228756.

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