Introduction/Background The standard of care for high-risk endometrial cancer is based on the results of the PORTEC 3 trial, which recommends adjuvant chemoradiotherapy and chemotherapy after surgery. However, in some countries, such as Tunisia, accessing radiotherapy machines can be challenging with significant delays. We aimed to report the feasibility and safety of the reversed sequence strategy.

Methodology We retrospectively collected 40 cases of high-risk endometrial cancer treated with the reversed PORTEC sequence between 2021–2022. All included patients met the eligibility criteria of the PORTEC 3 trial. Patients received adjuvant chemotherapy (4 cycles of carboplatin/paclitaxel) followed by concurrent chemo-radiotherapy (Cisplatin S1-S4). We described the patient’s characteristics, treatment administration intervals, toxicity, and survival results.

Results Mean age was 60 years with obesity in 40% of patients and hypertension in 53%. ECOG PS was 0–1 in 74% of patients. Histological subtypes were endometrioid (65%), serous(17.5%), and clear cell (7.5%). High-grade tumors were seen in 61%, with 59% of nodal involvement and 50% of lymph-vascular invasion. All patients had surgery consisting of hysterectomy and bilateral salpingo-oophorectomy in 70% of cases and lymph node dissection in 75%. The median time between surgery and chemotherapy was 3months (2–6 months) and between chemotherapy and concurrent chemo-radiotherapy 3 months (1–8 months). Chemotherapy all grades toxicities were reported in 35% of cases as follows: 65%neuropathy (5% G3),8% of G3–4 neutropenia (4% febrile neutropenia), 15% anemia, 10% thrombocytopenia, 25% gastrointestinal toxicities. No grade 3–4 toxicities were reported during concurrent chemo-radiotherapy. 94% of patients completed all therapy sequences. After a median follow-up of 15 months, the recurrence rate was 15% (33% locoregional, 67% metastatic). the median time to relapse of 14 months. Overall survival at 2 years was 80%.

Conclusion Reversed PORTEC sequence may be a feasible, safe, and effective treatment alternative for high-risk endometrial cancer to overcome the challenges of delayed radiotherapy initiation.

Disclosures No conflicts of interest.