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

• Published in: Journal of clinical oncology Vol. 27; no. 21; pp. 3547 - 3556
• Main Authors: NOUT, Remi A, PUTTER, Hein, SMIT, Vincent T. H. B. M, NIJMAN, Hans W, VAN DEN TOL, Philine P, CREUTZBERG, Carien L, JÜRGENLIEMK-SCHULZ, Ina M, JOBSEN, Jan J, LUTGENS, Ludy C. H. W, VAN DER STEEN-BANASIK, Elzbieta M, MENS, Jan Willem M, SLOT, Annerie, STENFERT KROESE, Marika C, VAN BUNNINGEN, BartN. F. M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20-07-2009
• Subjects: Activities of Daily Living - psychology; Adult; Aged, 80 and over; Biological and medical sciences; Endometrial Neoplasms - complications; Endometrial Neoplasms - psychology; Endometrial Neoplasms - radiotherapy; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Male; Medical sciences; Neoplasm Staging; Pelvis - radiation effects; Postoperative Period; Prostatic Neoplasms - complications; Prostatic Neoplasms - psychology; Prostatic Neoplasms - radiotherapy; Quality of Life - psychology; Radiation Injuries - complications; Radiation Oncology; Socioeconomic Factors; Surveys and Questionnaires; Treatment Outcome; Tumors; Endometrium cancer; Malignant tumor; Radiotherapy; Female genital diseases; Quality of life; Randomization; Cancerology; Treatment; Pelvic cavity; Uterine diseases; Clinical trial; Curietherapy; Cancer; Vaginal cancer; Primary cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2008.20.2424

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.