Outcomes of salvage high-dose-rate brachytherapy with or without external beam radiotherapy for isolated vaginal recurrence of endometrial cancer

Abstract

PurposeThis study was designed to retrospectively analyze outcomes of high-dose-rate (HDR) brachytherapy, with or without external beam radiotherapy (EBRT), in patients with vaginal recurrence of endometrial carcinoma, and to identify factors prognostic of patient outcomes.Material and methodsThe medical records of all patients who underwent HDR brachytherapy for initial recurrence in the vagina of endometrial cancer after definitive surgery between 1992 and 2014 were retrospectively reviewed. All patients underwent either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT) with or without EBRT. Late toxicity was graded using the EORTC (LENT/SOMA) scale, revised in 1995.ResultsThirty-seven patients were identified. The median follow-up time was 48 months (range: 6-225 months). Of these 37 patients, 23 underwent ICBT, 14 underwent ISBT, and 26 underwent EBRT. Tumor size at first examination of initial relapse was significantly larger in the ISBT than in the ICBT group. The 4-year respective overall survival (OS), local control (LC), and progression-free survival (PFS) rates in the entire cohort were 81.0%, 77.9%, and 56.8%, respectively. The interval between diagnosis of first recurrence and radiotherapy (< 3 months, ≥ 3 months) was a significant predictor of LC and PFS. OS and LC rates did not differ significantly in the ICBT and ISBT groups. Two patients experienced grade 2 rectal bleeding, and four experienced grade 2 hematuria. No grade 3 or higher late complications were observed.ConclusionsSalvage HDR brachytherapy is an optimal for treating vaginal recurrence of endometrial carcinoma with acceptable morbidity. Early radiotherapy, including brachytherapy, should be considered for women who experience vaginal recurrence of endometrial cancer.

Combined external beam radiotherapy and vaginal brachytherapy versus vaginal brachytherapy in stage I, intermediate- and high-risk cases of endometrium carcinoma

“…The most common side effects of HDR intravaginal brachytherapy in a retrospective study by Sourav et al . were mucosal telangiectasia, atrophy, stricture, or adhesions, similar the findings in this study [ 18 ]. Laliscia et al .…”

“…In a study by Sourav et al ., late radiation-induced bladder toxicity was noted in 27.3% of cases and 3.5% patients had experienced grade 3 adverse events. However, in the study by Sourav et al ., the findings were assessed for both endometrial and cervical cancers [ 18 ]. Sekii et al .…”

Mismatch repair deficiency identifies patients with high‐intermediate–risk (HIR) endometrioid endometrial cancer at the highest risk of recurrence: A prognostic biomarker

“…There was a relatively high rate of patients who received no adjuvant therapy in this data set of women with HIR EECs. Because isolated vaginal recurrences can be prevented very effectively with VBT and have a very high likelihood of salvage in the absence of prior radiation, we also analyzed our data set excluding those patients who had an isolated vaginal recurrence. Twelve patients (18.8%) with dMMR and 6 (4.5%) with iMMR developed a distant and/or retroperitoneal/regional recurrence (OR, 4.88; P = .001).…”

“…We acknowledge that a relatively high percentage of patients received no adjuvant therapy in our HIR EEC data set. Because isolated vaginal recurrences can be prevented very effectively with VBT and have a very high likelihood of salvage in the absence of prior radiation, we also analyzed our data set excluding patients who had an isolated vaginal recurrence. Even then, the recurrence rate was significantly higher for patients with dMMR (18.8% vs 4.5% for those with iMMR), with a corresponding decrease in 5‐year RFS (73.5% vs 95%, respectively).…”

Prospective observational study on the safety of an original fiducial marker insertion for radiotherapy in gynecological cancer by a simple method

“…In one case we used the original markers as useful references for daily correction in a patient who underwent multi-catheter interstitial brachytherapy; it was necessary to keep patients in bed overnight throughout the treatment period. Regarding vaginal recurrence of cervical cancer or endometrial cancer of which brachytherapy with EBRT is an effective treatment [ 11–14] , the markers are also helpful for contouring GTV in brachytherapy as with EBRT planning, considering tumor shrinkage after EBRT.…”