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Gynaecology: Endometrial — role of radiotherapy in stage I

Free question published 07 September 2026

GynaecologyEndometrial — role of radiotherapy in stage I

A 70-year-old woman has had a hysterectomy and bilateral salpingo-oophorectomy for a FIGO stage I grade 1 endometrioid adenocarcinoma with deep (greater than 50%) myometrial invasion. She is anxious about cancer returning and asks whether pelvic radiotherapy will help her live longer. Which counselling statement is most accurate?

  1. APelvic radiotherapy significantly improves both locoregional control and overall survival
  2. BPelvic radiotherapy has no effect on locoregional recurrence or survival
  3. CPelvic radiotherapy reduces distant metastasis but not local recurrence
  4. DPelvic radiotherapy improves overall survival without affecting local recurrence
  5. EPelvic radiotherapy reduces locoregional recurrence but not overall survival

Why E is correct

PORTEC-1 randomised stage I endometrial carcinoma to postoperative pelvic radiotherapy (46 Gy) or no further treatment. Radiotherapy reduced the 5-year locoregional recurrence rate from 14% to 4% (p<0.001) but did not improve overall survival (5-year survival 81% vs 85%, p=0.31), while adding treatment-related morbidity.

And why the others are not

  • AIncorrect. Overall survival was not improved (81% vs 85%, p=0.31).
  • BIncorrect. Locoregional recurrence was significantly reduced (14% to 4%).
  • CIncorrect. The benefit was on locoregional, not distant, control.
  • DIncorrect. Radiotherapy reduced local recurrence but did not improve survival, the reverse of this statement.

Source PORTEC-1 — postoperative pelvic radiotherapy vs no further treatment in stage I endometrial carcinoma — Creutzberg CL, et al (PORTEC Study Group). Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. Lancet, 2000.

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