Vaginal toxicity after high-dose-rate endovaginal brachytherapy: 20 years of results

Abstract

PurposeTo evaluate vaginal toxicity (primary endpoint) and local control (secondary endpoint) in patients with endometrial cancer who underwent primary surgery and adjuvant high-dose-rate (HDR) endovaginal brachytherapy (BT).Material and methodsIn September 2017, the authors conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus, and Cochrane library. In this systematic review, the authors included randomized trials, non-randomized trials, prospective studies, retrospective studies, and cases. The time period of the research included articles published from September 1997 to September 2017.ResultsAcute endovaginal toxicity occurred in less than 20.6% and all acute toxicities were G1-G2. The most common early side effects due to HDR-BT treatment were vaginal inflammation, vaginal irritation, dryness, discharge, soreness, swelling, and fungal infection. G1-G2 late toxicity occurred in less than 27.7%. Finally, G3-G4 late vaginal occurred in less than 2%. The most common late side effects consisted of vaginal discharge, dryness, itching, bleeding, fibrosis, telangiectasias, stenosis, short or narrow vagina, and dyspareunia.ConclusionsThe data suggest that HDR endovaginal brachytherapy, with or without chemotherapy, is very well tolerated with low rates of acute and late vaginal toxicities. Further prospective studies with higher numbers of patients and longer follow-up are necessary to evaluate acute and late toxicities after HDR endovaginal brachytherapy.

The role of vaginal brachytherapy in stage I endometrial serous cancer: a systematic review

“…Regarding late toxicity, our review showed that the treatment is very well tolerated. The main side effects consisted of grade G1-G2, while G3-G4 late vaginal toxicities have been reported only in few cases (range, 0-8%) in line with the current data in literature [49,50].…”

A cost-effectiveness analysis of three approaches for lymph node assessment in patients with low- and intermediate-risk endometrial cancer

“…The development of short-term side effects was based on two large trials. [28,29] The probability of bilateral SLN mapping is 79%. [19] The sensitivity of 97% for SLN mapping is based on a study by Rossi et al [14] The specificity is assumed to be 100%, since no false positive outcomes are possible with SLN.…”

One-week vaginal brachytherapy schedule as exclusive adjuvant post-operative treatment in intermediate- and high-intermediate-risk endometrial cancer patients

“…The role of exclusive VBT as a standard treatment in high-intermediate-risk EC patients has been recently confirmed by the long-term results of PORTEC-2 trial, in which, a dose of 21 Gy in 3 fractions of 7 Gy was delivered with one week interval between each fraction, and with the dose specified at 5 mm distance from the surface of cylinder [7]. Quite different fractionations and dose intensity (overall treatment time) schedule has been reported in literature, with local control ranging from 90% to 100% and with a rate of late vaginal toxicity, mainly G1-G2, ranging from 7.5% to 27.7% [6]. Other VBT schedules, which are used frequently include 5 Gy at 5 mm in 6 fractions, 5 Gy at 5 mm in 5 fractions, 7 Gy in 3 fractions at mucosa surface, and 5 Gy at 5 mm in 4 fractions [13].…”

“…A firm conclusion has been drawn from a randomized PORTEC-2 trial, which reported similar rates of locoregional relapse in early-stage EC patients with intermediate-risk who receive exclusive VBT, when compared with pelvic EBRT [3]. Although VBT as monotherapy represents now the standard adjuvant treatment for early-stage EC, including intermediate-(IR) and high-intermediate-risk (HIR) disease, there is a large variability among fractionations or total dose or dose intensity delivery [2,4,5,6,7,8]. Despite this high variability of fractionations, VBT has been related to satisfied rate of local control, ranging from 90% to 100%, and low-rate of late vaginal toxicity, mainly G1-G2, with a range from 7.5% to 27.7% [6].…”

“…Although VBT as monotherapy represents now the standard adjuvant treatment for early-stage EC, including intermediate-(IR) and high-intermediate-risk (HIR) disease, there is a large variability among fractionations or total dose or dose intensity delivery [2,4,5,6,7,8]. Despite this high variability of fractionations, VBT has been related to satisfied rate of local control, ranging from 90% to 100%, and low-rate of late vaginal toxicity, mainly G1-G2, with a range from 7.5% to 27.7% [6]. The most commonly employed fractionation consists of 21 Gy total dose, with 7 Gy each fraction, delivered once a week, as proposed by the PORTEC-2 trial [3].…”