PurposeHigh-dose-rate brachytherapy (HDR-BT) alone is an adjuvant treatment option for stage I intermediaterisk endometrial cancer after complete surgical resection. The aim of this study was to determine the value of the dose reported to ICRU bladder point in predicting acute urinary toxicity. Oncologic results are also presented.Material and methodsOne hundred twenty-six patients were treated with postoperative HDR-BT 24 Gy (4 × 6 Gy) per ICRU guidelines for dose reporting. Cox analysis was used to identify variables that affected local control. The mean bladder point dose was examined for its ability to predict acute urinary toxicity.ResultsTwo patients (1.6%) developed grade 1 gastrointestinal toxicity and 12 patients (9.5%) developed grades 1-2 urinary toxicity. No grade 3 or greater toxicity was observed. The mean bladder point dose was 46.9% (11.256 Gy) and 49.8% (11.952 Gy) for the asymptomatic and symptomatic groups, respectively (p = 0.69). After a median follow-up of 36.8 months, the 3-year local failure and 5-year cancer-specific and overall survival rates were 2.1%, 100%, and 94.6%, respectively. No pelvic failure was seen in this cohort. Age over 60 years (p = 0.48), lymphatic invasion (p = 0.77), FIGO histological grade (p = 0.76), isthmus invasion (p = 0.68), and applicator type (cylinder × ovoid) (p = 0.82) did not significantly affect local control.ConclusionsIn this retrospective study, ICRU bladder point did not correlate with urinary toxicity. Four fractions of 6 Gy HDR-BT effected satisfactory local control, with acceptable urinary and gastrointestinal toxicity.

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using Cox regression was used to assess the association of OS and variables including RT, age, and year of diagnosis. Results: 1382 patients diagnosed with TALL were identified. The median age at diagnosis was 9 years. There was a significant increase in the use of RT with 48.1% of patients between 2003 and 2012 receiving RT compared with 35.4% between 1980 and 2002 (P<0.001). Age at diagnosis and sex were not associated with differential use of radiation. On univariate analysis, RT was associated with an improvement in 5-year OS compared with no RT (81.6% vs. 73.7, P<0.001). OS was also improved for patients between 2003 and 2012 compared with 1980 and 2002 (84.8% vs. 69.0%, P<0.001), and age less than 10 years compared with age 10 years or older (80.6% vs. 73.1%, PZ0.001). On multivariate analysis, RT use (HRZ 0.672, PZ0.002), year of diagnosis between 2003 and 2012 (HRZ 0.464, P<0.001), and age at diagnosis <10 years (HRZ 0.635, P<0.001) all independently predicted for improved OS. Conclusion: In contrast to the majority of pediatric malignancies where RT use is decreasing, utilization of RT for TALL has been increasing. RT use is associated with improved OS independent of year of diagnosis and age of the patient. Limitations include the absence of data in the SEER database regarding chemotherapy, RT site, and CNS risk stratification of ALL patients.

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