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When Standards Meet Reality: An Inverted PORTEC-3 Protocol for High-Risk Endometrial Cancer in Resource-Limited

Raouia Ben Amor1,2, Ines Mlayeh1,2, Amal Riahi1,2

  • 1Radiation Oncology Departement, Abderrahmen Mami Hospital, Ariana 2080, Tunisia.

Cancers
|February 13, 2026
PubMed
Summary
This summary is machine-generated.

A chemotherapy-first approach for high-risk endometrial cancer shows good survival outcomes despite radiotherapy delays. However, increased hematologic toxicity necessitates bone marrow sparing strategies.

Keywords:
adjuvant chemoradiotherapybone marrow sparingdisease recurrenceendometrial cancerhematologic toxicityhigh-risk diseaseradiotherapy accesstreatment sequencing

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Area of Science:

  • Gynecology
  • Oncology
  • Radiation Oncology

Background:

  • Standard adjuvant treatment for high-risk endometrial cancer combines chemotherapy and radiotherapy.
  • Radiotherapy access limitations can cause treatment delays, potentially impacting patient outcomes.

Purpose of the Study:

  • To evaluate oncologic outcomes and toxicity of an inverted sequence: upfront chemotherapy followed by chemoradiotherapy.
  • To assess the impact of treatment delays on survival in high-risk endometrial cancer.

Main Methods:

  • Retrospective single-center study of 52 patients with high-risk endometrial cancer.
  • Patients received paclitaxel-carboplatin chemotherapy followed by pelvic radiotherapy with concurrent cisplatin.
  • Survival outcomes and acute hematologic toxicity were analyzed; bone marrow dose-volume parameters were evaluated.

Main Results:

  • Five-year overall survival and disease-free survival rates were 86.1% and 77.5%, respectively.
  • Treatment delays exceeding 10 weeks for chemotherapy or 20 weeks for radiotherapy were linked to reduced disease-free survival.
  • Grade ≥2 hematologic toxicity was frequent; bone marrow dose thresholds (V40 Gy < 20-25%, V30 Gy < 40%) predicted toxicity.

Conclusions:

  • A chemotherapy-first strategy yields favorable oncologic outcomes and locoregional control in high-risk endometrial cancer, especially when radiotherapy is delayed.
  • Increased hematologic toxicity underscores the need for optimized bone marrow sparing techniques.
  • This approach offers a viable alternative when timely radiotherapy is challenging.