FRCR VAULT

Gynaecology: Endometrial — adjuvant management by risk group

Free question published 27 August 2026

GynaecologyEndometrial — adjuvant management by risk group

A 68-year-old woman has had a total hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer. Final pathology shows a FIGO stage IA (less than 50% myometrial invasion) grade 3 endometrioid adenocarcinoma with no lymphovascular space invasion; she is otherwise classed as high-intermediate risk. She is keen to minimise bowel toxicity. What is the most appropriate adjuvant treatment?

  1. APelvic external beam radiotherapy with concurrent and adjuvant chemotherapy
  2. BObservation with no adjuvant radiotherapy
  3. CVaginal brachytherapy
  4. DPelvic external beam radiotherapy
  5. EAdjuvant carboplatin and paclitaxel alone

Why C is correct

PORTEC-2 randomised high-intermediate-risk stage I-IIA endometrial cancer to vaginal brachytherapy or pelvic external beam radiotherapy. Vaginal recurrence rates were equivalent (1.8% vs 1.6%) with no difference in survival, but vaginal brachytherapy caused markedly less gastrointestinal toxicity. The trial concluded vaginal brachytherapy should be the adjuvant treatment of choice for this risk group.

And why the others are not

  • AIncorrect. Chemoradiotherapy is the PORTEC-3 high-risk strategy; this stage IA disease is high-intermediate, not high, risk.
  • BIncorrect. High-intermediate-risk disease carries enough vaginal recurrence risk that adjuvant vaginal brachytherapy is recommended over observation.
  • DIncorrect. Pelvic EBRT offers no survival or vaginal-control advantage in this group but causes substantially more gastrointestinal toxicity.
  • EIncorrect. Adjuvant chemotherapy alone is not the PORTEC-2 standard for high-intermediate-risk disease.

Source PORTEC-2 — vaginal brachytherapy vs pelvic external beam radiotherapy in high-intermediate-risk endometrial cancer — Nout RA, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet, 2010.

More free gynaecology questions

2,500+ cited questions like this one are waiting in the vault.

See plans and pricing