Geraldine M. Jacobson, MD, MPH, MBA

GERALDINE M. JACOBSON, MD, MPH, MBA, ASTRO Secretary/Treasurer, Professor and Chair of Radiation Oncology at the West Virginia University School of Medicine, Morgantown, went into more detail about the importance of this study. “The study directly compared brachytherapy/chemotherapy, which we use empirically based on two lines of evidence, vs pelvic radiotherapy, which is a documented standard. For the first time, we have a direct comparison. Brachytherapy/chemotherapy is not superior to pelvic radiation. Overall and relapse-free survival are equivalent. The main difference between these two techniques favoring pelvic radiotherapy is locoregional control and less acute toxicity,” she explained. 

“The dissemination of these results is important in influencing clinical practice. Not everyone who treats endometrial cancer will read about the study,” she added. “Typically, treatment selection for endometrial cancer is influenced by a gynecologist or gynecologic oncologist. Whether this report will change practice is difficult to predict. While local control is improved, there is not a difference in relapse-free or overall survival.” 

Commenting further, she noted: “The elephant in the room is financial incentives.” 

Regarding the side effects of both treatments, Dr. Jacobson acknowledged that both acute and long-term effects are key considerations. “Acute side effects are important to the patient and affect the experience of treatment. They can compromise compliance,” she said, “which impacts treatment outcome.” 

Two Different Lines of Research Converge 

“VAGINAL BRACHYTHERAPY has become more widely used based on the PORTEC study, which showed comparable vaginal control and survival with vaginal brachytherapy compared with pelvic radiation,” Dr. Jacobson explained. “The strategy of incorporating chemotherapy came from a separate trial that demonstrated the benefit of chemotherapy compared with radiation for high-risk endometrial cancer.” 

Dr. Jacobson continued: “Two different lines of research converged, and we are treating patients empirically with brachytherapy/chemotherapy. Now we have the results of this trial, and we see that chemotherapy does not compensate for the omission of pelvic radiotherapy in terms of local control. We have to use this new evidence in our discussions with patients. There may be some patients who opt for brachytherapy/chemotherapy for reasons that have to do with the number of treatment days, transportation issues, and other considerations,” she revealed. 

“Overall, this study shows we had assumptions [about brachytherapy/chemotherapy] that were not borne out. Vaginal brachytherapy/ chemotherapy is not superior for patients with high-risk endometrial cancer. Pelvic radiotherapy has less acute toxicity and is associated with fewer pelvic and para-aortic recurrences,” said Dr. Jacobson. ■

DISCLOSURE: Dr. Jacobson reported no conflicts of interest.