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Low dose adjuvant cylinder brachytherapy for endometrioid endometrial cancer: Vaginal brachytherapy for endometrial cancer



Low dose adjuvant cylinder brachytherapy for endometrioid endometrial cancer: Vaginal brachytherapy for endometrial cancer



Practical Radiation Oncology 2019:



To evaluate outcomes and sites of failure for women with early stage endometrial adenocarcinoma treated with adjuvant high-dose-date (HDR) vaginal brachytherapy (VB) with a low dose scheme. Retrospective review identified 318 patients with FIGO stage I-II endometrioid endometrial cancer who received adjuvant HDR VB to a dose of 24 Gy in 6 fractions from 2005-2017. Patients with <6 months follow-up were excluded. Dose was prescribed to cylinder surface and CT imaging was performed prior to each fraction to assess cylinder placement. Rates of vaginal relapse (VR), pelvic nodal relapse (PNR), distant metastasis (DM), recurrence-free survival (RFS) and overall survival (OS) were calculated by Kaplan-Meier method. Univariate analysis was performed by logrank test or Cox proportional hazards. Pre-treatment CT images were analyzed for patients with VR. Median follow-up was 42 months for 243 patients. The 3-year rates of VR, PNR, DM, RFS and OS were 1.9%, 1.5%, 4.3%, 94.1% and 98.9%, respectively. The 3-year VR rates by GOG-99 risk groups were 0%, 1.4% and 3.2% for LR, LIR, and HIR disease (p=0.5). By PORTEC risk stratification, 3-year VR rate was 1.3% for HIR disease. On review of pre-treatment CT images of 6 patients with VR, 3 patients had relapse at the introitus outside the treated vaginal length, and 3 had in-field recurrence at the vaginal apex. Higher BMI was associated with VR, with a 14% increase in risk per BMI unit (kg/m2, p=0.02). There were no reported grade 2 GI or any grade 3 toxicities. Adjuvant HDR VB with a low dose regimen results in excellent clinical outcomes for patients with early stage endometrioid endometrial cancer. Patients with higher BMI may be at increased risk of VR, and additional study is needed to optimize brachytherapy treatment parameters.

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Accession: 069567143

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PMID: 31783169


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