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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