High-dose-rate postoperative vaginal cuff irradiation alone for stage Ib and Ic endometrial cancer

Anderson, John M.; Stea, Baldassarre; Hallum, Alton V.; Rogoff, Edward E.; Childers, Joel M.

doi:10.1016/s0360-3016(99)00427-7

Cited by 120 publications

(42 citation statements)

References 34 publications

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“…Adjuvant radiation therapy to the pelvis has been used to treat residual disease and reduce the risk of pelvic recurrence in such patients (5)(6)(7)(8)(9). Unfortunately, many women with high-risk pathological features ultimately develop extrapelvic metastases, despite receiving adjuvant radiation therapy (10 -15).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of E-Cadherin Protein Expression in Pathological Stage I-III Endometrial Cancer

Mell¹,

Meyer²,

Tretiakova³

et al. 2004

Clinical Cancer Research

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Purpose: Decreased expression of E-cadherin in endometrial cancer cells is associated with adverse prognostic features. This study aimed to evaluate the prognostic significance of decreased E-cadherin expression in patients with endometrial cancer.Experimental Design: Between 1992 and 1999, 102 endometrial cancer patients with stage I-III disease underwent primary surgery at the University of Chicago. Representative tissue specimens were immunostained with a monoclonal antibody to E-cadherin. A semiquantitative evaluation scale was developed based on the percentage of endometrial cancer cells with membranous E-cadherin staining. Tissue sections were scored as "3" if >75%, "2" if 25-75%, "1" if 5-25%, and "0" if <5% of cells stained. E-Cadherin staining was correlated with overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and extrapelvic progression. Multivariate Cox proportional hazards modeling was used to estimate hazard ratios, controlling for clinicopathological characteristics and adjuvant treatment. Median follow-up for the study group was 58.5 months.Results: E-Cadherin staining was scored as 0, 1, 2, and 3 in 29.4%, 18.6%, 26.5%, 25.5% of cases, respectively. E-Cadherin expression was positively correlated with myometrial invasion (Kendall : 0.30, P < 0.01), and negatively correlated with grade (Kendall : ؊0.13, P ‫؍‬ 0.15) and papillary serous or clear cell histology (Kendall : ؊0.14, P ‫؍‬ 0.12). Five-year actuarial OS, CSS, PFS, and extrapelvic recurrence rates for negative (score ‫؍‬ 0), heterogeneous Conclusions: Decreased E-cadherin expression is an independent prognostic factor for disease progression and mortality in pathological stage I-III endometrial cancer. Evaluation of E-cadherin expression may aid in the selection of patients for more aggressive adjuvant therapy.

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Section: Introductionmentioning

confidence: 99%

Prognostic Significance of E-Cadherin Protein Expression in Pathological Stage I-III Endometrial Cancer

Mell¹,

Meyer²,

Tretiakova³

et al. 2004

Clinical Cancer Research

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“…Evidence of favorable clinical outcomes persists, especially an improved survival rate and a quicker treatment recovery time when using single‐channel VC HDR BT 2 , 4 , 5 , 6 , 7 . In particular, a simulation study by Barney et al (3) evaluating rectal and bladder toxicity using a single‐channel VC HDR BT reported that less than 5% of the patients (1 out of 24) developed a Grade 3 or higher toxicity level.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation therapy after hysterectomy is the standard treatment for stage I–IV endometrial cancer. In particular, high‐dose‐rate (HDR) vaginal cuff brachytherapy (BT) without external beam radiation therapy (EBRT) has been widely used due to its efficacy, especially low local recurrence with minimal toxicity, low morbidity, and favorable quality of life after treatment 2 , 3 , 4 , 5 , 6 , 7 . The most common applicator used for HDR BT is a vaginal cylinder (VC) with a single, central channel (8) .…”

Section: Introductionmentioning

confidence: 99%

Bladder and rectum dose estimations on digitized radiographs for vaginal brachytherapy after hysterectomy

Zhang

Bhatia

Sun

et al. 2014

J Applied Clin Med Phys

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The purpose of this study was to evaluate the feasibility of assessing bladder and rectal point doses, using orthogonal radiographs without treatment planning, for vaginal cylinder applicator (VC), high‐dose‐rate (HDR) vaginal cuff brachytherapy (BT) after hysterectomy. Thirty‐three VC HDR BT treatment plans from 31 postoperative endometrial cancer patients were retrospectively analyzed. Single‐channel VC with four differing diameters — 2.0 cm, 2.3 cm, 2.6 cm, and 3.0 cm — were analyzed. Dose‐distance modeling was performed to estimate bladder and rectal point doses by measuring distances on each orthogonal radiograph without treatment planning. The estimated doses were then compared with doses calculated on treatment planning system (TPS). Their percent (%) dose differences were recorded. Analysis was performed for each VC size, ICRU bladder and rectal points, and the closest rectal point. The estimated doses obtained from dose‐distance modeling displayed on average less than 2.5% difference when compared with TPS doses at ICRU bladder and rectal points for each VC size. Dose percent differences between estimated values and TPS values were on average 1.9% and 2.5% for ICRU bladder and rectal point, respectively, regardless of VC sizes. Dose‐distance modeling for closest rectal point presented on average 5.4% dose difference when compared with TPS values of all VC sizes. It was feasible to estimate rectal and bladder point doses by measuring distances on orthogonal radiographs without treatment planning. Percent dose differences were 2.5% less for both ICRU bladder and rectal points, regardless of VC sizes. The use of closest rectal point is not recommended for estimating rectal dose.PACS number: 87.53.‐j, 87.53.Jw, 87.55.‐x, 87.55.D‐, 87.55dk

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“…There has never been a randomized trial comparing IVBT alone to pelvic alone, but most data in the literature on highdose rate (HDR)-IVBT show a rate of vaginal recurrence similar to that with pelvic RT (0-2%) and a very favorable rate (0-1%) of significant late sequences [4,6,18,28,33].…”

Section: Adjuvant Rt In Stage Ib Endometrial Cancermentioning

confidence: 99%

Stage IB Endometrial Cancer

et al. 2007

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Overall survival may not be the only ideal endpoint for stage IB endometrial cancer since causes of death are mostly other than endometrial cancer. Conventional pelvic RT may be overtreatment in some patients, in particular in those patients with a large number of negative lymph nodes after lymphadenectomy. However, negative surgical staging should not be understood as adjuvant RT can be omitted in all patients.

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High-dose-rate postoperative vaginal cuff irradiation alone for stage Ib and Ic endometrial cancer

Cited by 120 publications

References 34 publications

Prognostic Significance of E-Cadherin Protein Expression in Pathological Stage I-III Endometrial Cancer

Prognostic Significance of E-Cadherin Protein Expression in Pathological Stage I-III Endometrial Cancer

Bladder and rectum dose estimations on digitized radiographs for vaginal brachytherapy after hysterectomy

Stage IB Endometrial Cancer

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