title: Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial.
abstract: OBJECTIVE
  Stage IC, grade 3 endometrial cancer is regarded as a high-risk category. Stage IC, grade 3 patients were not eligible for the randomized Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial, but were registered and received postoperative radiotherapy.
  
  
  METHODS
  The PORTEC trial included 715 patients with stage IC, grade 1 or 2, and stage IB, grade 2 or 3 endometrial cancer. Patients were randomly assigned after surgery to receive pelvic radiotherapy (RT) or no further treatment. A total of 104 patients with stage IC, grade 3 endometrial cancer were registered, of whom 99 could be evaluated. Patterns of relapse and survival were compared with PORTEC patients receiving RT. Median follow-up was 83 months.
  
  
  RESULTS
  The actuarial 5-year rates of locoregional relapse were 1% to 3% for PORTEC patients who received RT, compared with 14% for stage IC, grade 3 patients. Five-year distant metastases rates were 3% to 8% for grade 1 and 2 tumors; 20% for stage IB, grade 3 tumors; and 31% for stage IC, grade 3 tumors. Overall survival rates were 83% to 85% for grades 1 and 2; 74% for stage IB, grade 3; and 58% for stage IC, grade 3 patients (P <.001). In multivariate analysis grade 3 was the most important adverse prognostic factor for relapse and death as a result of endometrial cancer (hazard ratios, 5.4 and 5.5; P <.0001).
  
  
  CONCLUSIONS
  Patients with stage IC, grade 3 endometrial carcinoma are at high risk of early distant spread and endometrial carcinoma-related death. Novel strategies for adjuvant therapy should be explored to improve survival for this patient group.
authors.affiliation: Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, the Netherlands. c.l.creutzberg@lumc.nl
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
authors.forename: Wim L J
authors.initials: WL
authors.lastname: van Putten
authors.forename: Carla C
authors.initials: CC
authors.lastname: Wárlám-Rodenhuis
authors.forename: Alfons C M
authors.initials: AC
authors.lastname: van den Bergh
authors.forename: Karin A J
authors.initials: KA
authors.lastname: de Winter
authors.forename: Peter C M
authors.initials: PC
authors.lastname: Koper
authors.forename: Marnix L M
authors.initials: ML
authors.lastname: Lybeert
authors.forename: Annerie
authors.initials: A
authors.lastname: Slot
authors.forename: Ludy C H W
authors.initials: LC
authors.lastname: Lutgens
authors.forename: Marika C
authors.initials: MC
authors.lastname: Stenfert Kroese
authors.forename: Henk
authors.initials: H
authors.lastname: Beerman
authors.forename: Mat
authors.initials: M
authors.lastname: van Lent
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome