Impact of vaginal brachytherapy in intermediate and high-intermediate risk endometrial cancer: a multicenter study from the FRANCOGYN group

Abstract

Objective According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS). Methods Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups. Conclusions VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.

Improving locoregional outcome in high-intermediate-risk and high-risk stage I endometrial cancer with surgical staging followed by brachytherapy

“…At 15 years, locoregional recurrence rate was reported as 5.8% in external beam radiotherapy (EBRT) arm and 15.5% in follow-up arm (p < 0.001). In this trial, since the authors reported that vagina was the most frequent site of recurrence in 75% patients undergoing surgery alone [19], they concluded that vaginal brachytherapy (VBT) alone is effective treatment to obtain vaginal control avoiding PORT-related complications [20][21][22][23][24][25].…”