Adjuvant vaginal cuff brachytherapy for high-risk, early stage endometrial cancer

Abstract

PurposeTo report outcomes following adjuvant high-dose-rate vaginal brachytherapy (VBT) with or without chemotherapy for high-intermediate risk (HIR) and high-risk, early stage endometrial cancer as defined in Gynecologic Oncology Group trial 0249.Material and methodsFrom May 2000 to January 2014, 68 women with HIR and high-risk endometrial cancer underwent surgical staging followed by VBT. Median VBT dose was 21 Gy delivered in three fractions prescribed to 0.5 cm depth. Paclitaxel 175 mg/m2 and carboplatin area under the curve 6 was administered every 21 days in sequence with VBT. Actuarial survival estimates were calculated using the Kaplan-Meier method.ResultsPatient demographics included a median age of 66 years (range: 36-91) and stages IA (49%), IB (38%), and II (13%), respectively. Thirty-one (46%) patients had HIR disease with endometrioid histology, and 33 (48%) patients had serous or clear cell histology. Thirty-seven (54%) patients received a median 3 cycles (range: 3-6) of chemotherapy in addition to VBT, and 65 patients (96%) completed all prescribed therapy. During a median follow up of 33.1 months (range: 4.0-161.7), four patients have recurred, including one vaginal recurrence. The 3-year estimates of vaginal, pelvic, and distant recurrences were 1.9%, 2.4%, and 9.1%, respectively. The 3-year rates of disease-free and overall survival were 87.7% and 93.9%, respectively.ConclusionsEarly outcomes with adjuvant VBT with or without chemotherapy demonstrate high rates of vaginal and pelvic control for women with HIR disease. Early vaginal and pelvic relapses in high-risk patients suggest that pelvic external beam radiotherapy is warranted in this subgroup, but additional data from large phase III trials is warranted.

American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review

“…Table 4 describes the outcomes of VBT with or without CT for patients with high risk histologies. Vaginal failure is generally low (range of 0–2.7%) though pelvic failure ranges from 0–9.0% for patients with stage I–II disease [33,55–59]. …”

Improved Outcome of High-Grade, Early 1-Stage Endometrioid Endometrial Carcinoma With Adjuvant Chemotherapy and Radiotherapy

“…27,28 It is interesting to note that over time the application of chemotherapy in endometrial cancer has been adopted by clinicians in patients with high-risk endometrial cancer as shown in a recently published questionnaire among members of the Society of Gynecologic Oncologists and supported by data that VBT alone is not sufficient in patients with high-risk EC. 29,30 Although our data support the consideration of adjuvant chemotherapy in high-risk endometrial cancer patients, data should be confirmed by randomized trials. Especially, because early data of the GOG 249 study, that randomized high-intermediate-, and high-risk patients between pelvic EBRT and vaginal brachytherapy followed by chemotherapy (3 cycles of carboplatin and paclitaxel) did not show a benefit with respect to PFS of adjuvant chemotherapy over standard EBRT.…”

Treatment Results of Adjuvant Brachytherapy as Monotherapy in Endometrial Cancer: A Retrospective Study from Faculty of Medicine, Chiang Mai University

“…Chadha .1%, respectively. The 3-yr disease-free and overall survival rates were 87.7% and 93.9%, respectively [15].…”