External Pelvic and Vaginal Irradiation Versus Vaginal Irradiation Alone as Postoperative Therapy in Medium-Risk Endometrial Carcinoma: A Prospective, Randomized Study—Quality-of-Life Analysis

Sorbe, Bengt; Horváth, György; Andersson, H; Boman, Karin; Lundgren, Caroline; Pettersson, B.

doi:10.1097/igc.0b013e3182643ba0

Cited by 49 publications

(27 citation statements)

References 29 publications

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“…As with reports of either EBRT or VBT alone, the combination of EBRT and VBT results in excellent locoregional control with vaginal recurrences of 0–2.7% and pelvic recurrences of 0.3–4.0% [2,31,34,36–39]. There is no randomized data of EBRT +/− VBT, though VBT boost is often performed for patients who are felt to benefit from EBRT with a higher risk of a vaginal failure, particularly when a modestly lower dose of pelvic radiation (45 Gy at 1.8 Gy/fraction) is delivered relative to doses used in randomized trials (46 Gy at 2 Gy per fraction or 50.4 Gy at 1.8 Gy per fraction).…”

Section: Vaginal Brachytherapysupporting

confidence: 59%

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

et al. 2017

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This article aims to review the risk stratification of endometrial cancer, treatment rationale, outcomes, treatment planning, and treatment recommendations of vaginal brachytherapy (VBT) in the post-operative management of endometrial cancer patients. The authors performed a thorough review of the literature and reference pertinent articles pertaining to the aims of this review. Adjuvant VBT for early stage endometrial cancer patients results in very low rates of vaginal recurrence (0–3.1%) with low rates of late toxicity which are primarily vaginal in nature. PORTEC-2 supports that VBT results in non-inferior rates of vaginal recurrence compared to external beam radiotherapy (EBRT) for the treatment of high-intermediate risk patients. VBT as a boost following EBRT, in combination with chemotherapy, and for high-risk histologies have shown excellent results as well though randomized data do not exist supporting VBT boost. There are many different applicators, dose-fractionation schedules, and treatment planning techniques which all result in favorable clinical outcomes and low rates of toxicity. Recommendations have been published by the American Brachytherapy Society and the American Society of Radiation Oncology to help guide practitioners in the use of VBT. Data support that patients and physicians both prefer joint decision-making regarding the use of VBT, and patients often desire additional treatment for a marginal benefit in risk of recurrence. Discussions regarding adjuvant therapy for endometrial cancer are best performed in a multi-disciplinary setting and patients should be counseled properly regarding the risks and benefits of adjuvant therapy.

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Section: Vaginal Brachytherapysupporting

confidence: 59%

“…They found overall pelvic relapse rate to be 0.4% with EBRT plus VBT boost and 5.3% with VBT alone (p=0.013). There were no differences in vaginal recurrence or overall survival, and toxicity was decreased with VBT alone [31]. …”

Section: Vaginal Brachytherapymentioning

confidence: 99%

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

et al. 2017

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“…In the abovementioned trial by Sorbe et al, all (grade 1 to 3) late reactions were recorded in 2.7% of cases administered VBT alone, with grade 3 urinary tract side effects in 0.8% [5]. Grade 3 or worse complications were reported in 0.8% of patients in the abovementioned retrospective study of HDR VBT to a lenght of 5 cm and 6 cm of the vagina [6].…”

Section: Discussionmentioning

confidence: 99%

“…In that trial, the reference isodose covered the proximal half of the vagina. The 5-year actuarial locoregional relapse rate of 5% and the vaginal recurrence rate of 2.7% in the VBT group alone were reported in another randomised trial, which compared external pelvic and vaginal irradiation versus vaginal irradiation alone in medium-risk group endometrial cancer patients [5]. In that trial, lowrisk and high-risk cases were included, thus the study populations were not fully comparable with those entered into the PORTEC-2.…”

Section: Discussionmentioning

confidence: 99%

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Pulsed-dose-rate post-operative vaginal cuff brachytherapy for endometrial cancer: preliminary report

Serkies¹,

Pawłowska²,

Kamińska³

et al. 2015

jcb

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Purpose: To present our early experience with the post-operative intracavitary pulsed-dose-rate vaginal brachytherapy (PDR VBT) in high-intermediate risk endometrial cancer patients as defined in the PORTEC-2 trial.Material and methods: The study group included 60 high-intermediate risk endometrial cancer patients with a median age of 64 (range: 57-87) treated between April 2010 and December 2013 with PDR VBT at a dose of 18 Gy (range: 17-27); 1 Gy/pulse, pulses repeated every hour. Prior surgery consisted of a total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without a lymphadenectomy.Results: After a median follow-up of 23 months there were two local recurrences, both located in the lower part of the vagina, outside of the irradiated area. One of the relapsed women was susccessfully salvaged with surgery followed by pelvic irradiation and remained free of the disease for the subsequent three years. Following therapy, 24 (40%) of the patients experienced grade 1 or 2 urinary and/or bowel toxicity. There was one case with a serious post-surgical (grade 3) urinal side effect.Conclusions: Post-operative PDR VBT at a dose of 18 Gy/18 pulses/every hour seems to be a safe technique and ensures vaginal control in high-intermediate risk endometrial cancer patients. Additional follow-up including larger number of patients is necessary for the final assessment of this therapy.

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Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

Lawrie

Green

Beresford

et al. 2018

Cochrane Database of Systematic Reviews

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Conformal radiotherapy techniques are an improvement on older radiotherapy techniques. IMRT may be better than 3DCRT in terms of GI toxicity, but the evidence to support this is uncertain. There is no high-quality evidence to support the use of any other prophylactic intervention evaluated. However, evidence on some potential interventions shows that they probably have no role to play in reducing RT-related GI toxicity. More RCTs are needed for interventions with limited evidence suggesting potential benefits.

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External Pelvic and Vaginal Irradiation Versus Vaginal Irradiation Alone as Postoperative Therapy in Medium-Risk Endometrial Carcinoma: A Prospective, Randomized Study—Quality-of-Life Analysis

Cited by 49 publications

References 29 publications

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

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

Pulsed-dose-rate post-operative vaginal cuff brachytherapy for endometrial cancer: preliminary report

Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers

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