Do PORTEC-3 and GOG-258 change your approach to managing patients with high-risk or node positive endometrial cancer?  

The ambiguous answer is "yes and no." The positive impact of RT on vaginal and nodal failure rates cannot be ignored and argues for a continued role for RT, probably external RT.  There are a number of caveats relative to the interpretations of GOG 258. These include (but may not be limited to...

Based on PORTEC 3, there is a limited benefit of chemo in high risk stage I and II disease (similar to GOG 249) and an improvement in outcome for stage III endometrioid disease (randomization was chemo RT vs. RT). GOG 258 for advanced stage shows a significant decrease in locoregional recurrence (28...

We should await final publication of GOG 258, but the results unfortunately will be interpreted as a negative study for combined chemo+RT. This despite the significant locoregional benefit of radiation of 15%It should be noted that while the study is described as having Stage III endometrial cancer...