Isolated Vaginal Recurrences in Endometrial Carcinoma: Treatment Results Using High-Dose-Rate Intracavitary Brachytherapy and External Beam Radiotherapy

Pai, Howard; Souhami, Luís; Clark, Brenda; Roman, Ted N.

doi:10.1006/gyno.1997.4752

Cited by 53 publications

(17 citation statements)

References 16 publications

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“…It has been speculated that neoplastic seeding (i.e., "spillage") at the time of hysterectomy may account for the development of vaginal apical recurrences, while retrograde spread via the rich network of lymphatics could account in particular for suburethral and distal vaginal recurrences. Still other investigators favor [19] 1988 46 5 42 Poulsen [20] 1988 21 10 47 Kuten [21] 1989 17 4.8 40 Morgan [22] 1993 34 5 60 Pai [23] 1997 20 10 46 venous dissemination over lymphatic spread as a mechanism of vaginal recurrence in endometrial cancer, since vaginal metastases are relatively uncommon in other cancers where lymphatic spread is common, such as carcinoma of the cervix. Indeed, other malignant neoplasms notorious for hematogenous metastases, such as choriocarcinoma and hypernephroma, often seed the vaginal wall.…”

Section: Discussionmentioning

confidence: 99%

“…Series published from 1987 to 1993 which have contained 18 to 51 patients have documented severe complications in 10 -16% of patients following treatment [18,21,22]. Although Pai and co-workers rescued fewer than 50% of patients utilizing modern high-dose-rate intracavitary brachytherapy, they observed a 25% acute complication rate and only one severe late complication attributable to radiotherapy in their series of 20 patients with vaginal recurrence [23]. As in the present series, there is a predominance of rectal and colonic toxicities distributed throughout these literatures.…”

Section: Discussionmentioning

confidence: 99%

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Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Tewari¹,

Cappuccini²,

Brewster³

et al. 1999

Gynecologic Oncology

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Objective. The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma.Methods. Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death.Results. The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n ‫؍‬ 18), Stage II (n ‫؍‬ 7), and Stage III (n ‫؍‬ 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingooophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n ‫؍‬ 5) or at distant sites (n ‫؍‬ 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n ‫؍‬ 2), fistula (n ‫؍‬ 2), and radiation stricture (n ‫؍‬ 1).Conclusion. Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Tewari¹,

Cappuccini²,

Brewster³

et al. 1999

Gynecologic Oncology

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“…Despite the effectiveness of surgery in the management of early-stage disease, relapse is common in those with high-risk features. Pelvic relapse occurs in 10 – 15% of intermediate-risk and 20 – 26% of high-risk patients (1, 5, 10–15). Approximately 75 – 80% of these relapses are confined to the vagina (16–20).…”

Section: Introductionmentioning

confidence: 99%

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

et al. 2017

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Purpose To compare clinical outcomes of MR-based versus CT-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). Methods We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier (K-M) survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS) and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. Results Median follow up was 33 months (CT 30 months, MR 35 months). Median cumulative EQD2 was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p=0.58). MR patients were older (p=0.03) and had larger tumor size (>4cm vs ≤4cm) compared to CT patients (p=0.04). For MR- vs. CT-based ISBT, 3-year KM rate for LC was 100% vs. 78% (p = 0.04), DFI was 69% vs. 55% (p= 0.1), and OS was 63% vs. 75% (p= 0.81), respectively. On multivariate analysis, tumor grade 3 was associated with worse OS (HR 3.57, 95%CI 1.25,11.36) in a model with MR-ISBT (HR=0.56, 95%CI 0.16,1.89). Toxicities were not significantly different between the two modalities. Conclusion Despite worse patient prognostic features, MR-ISBT was associated with a significantly better (100%) 3-year local control, comparable survival, and improved DFI rates compared to CT. Toxicities did not differ compared to CT-ISBT patients. Tumor grade contributed as the most significant predictor for survival. Larger prospective studies are needed to assess the impact of MR-ISBT on survival outcomes.

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“…In addition, small locoregional recurrences have a relatively high salvage rate in radiation-naive patients. Fiveyear survival for patients with isolated vaginal cuff recurrences using combinations of external radiation (EBRT) and brachytherapy (either interstitial or intracavitary) is approximately 60-70% [24][25][26][27][28] and 25-50% when including pelvic recurrences [6,7]. Other options include radical surgery +/− radiation therapy and chemotherapy.…”

Section: Recurrent Endometrial Cancermentioning

confidence: 99%