Adjuvant high-dose rate brachytherapy with or without external beam radiotherapy post-hysterectomy for endometrial cancer

Abstract

The purpose of this study was to evaluate patient selection, local control, survival and late toxicity of posthysterectomy adjuvant radiotherapy and compare adjuvant external beam therapy and high-dose rate (HDR) brachytherapy versus HDR brachytherapy alone. A retrospective analysis was performed on a series of 225 patients with endometrial cancer treated with external beam radiotherapy and HDR brachytherapy or HDR brachytherapy alone posthysterectomy from 1985 to June 1993. Of these 225 patients, 82 received external beam radiotherapy and brachytherapy and 143 received brachytherapy alone. The HDR fraction size was 8.5 Gy prescribed to the mucosal surface; two fractions were given after external beam and four fractions if brachytherapy alone was used. The median follow-up was 6.9 years. The patients who received combined external beam and brachytherapy had higher stage and grade tumors. The survival outcome was similar for either group when matched for stage. Overall relapse-free survival at five years was 96% and 81%, respectively for brachytherapy alone and combined adjuvant therapy. Pelvic recurrence was seen in 2.7% of patients. Toxicity was more common with external beam radiotherapy and brachytherapy compared to brachytherapy alone (45.1% vs 23.1%, P = 0.003). However, moderate or severe toxicity was rare but again was more common in the combined radiotherapy group (8.5% vs 2.1%, P = 0.04). There was a non-significant trend to increased toxicity after lymphadenectomy and external beam radiotherapy compared with patients who did not have a staging lymphadenectomy prior to external beam radiotherapy (62% vs 38%, P = 0.16). Adjuvant radiotherapy can be individualized and be based upon the information provided by the pathological specimens, which excluded external beam radiotherapy if a lymphadenectomy was performed and there was no evidence of extra-uterine disease. This study found more toxicity associated with adjuvant radiotherapy compared with other studies, but this may reflect different reporting criteria. There was more toxicity related to external beam radiotherapy and brachytherapy compared to brachytherapy alone. The two HDR brachytherapy protocols used in this series appear effective and safe.

The morbidity of surgery and adjuvant radiotherapy in the management of endometrial carcinoma

“…In the literature, the incidence of vaginal stenosis following postoperative radiotherapy varies considerably and ranges from 1.5% to 37%, but the criteria for diagnosis is rarely mentioned, and variable treatment regimes and methods are often used (14) . A higher dose rate/fraction, the use of small diameter molds (< 20 mm), and the length of vagina irradiated can all contribute to stenosis (14,15) . Our methods of delivering brachytherapy do not suggest overtreatment; only three patients received mold diameters of 20 mm and full vaginal irradiation was not carried out.…”

“…For the group as a whole, the high rate of vaginal stenosis and mucosal damage was a concern and much higher than that reported in other series. In the literature, the incidence of vaginal stenosis following postoperative radiotherapy varies considerably and ranges from 1.5% to 37%, but the criteria for diagnosis is rarely mentioned, and variable treatment regimes and methods are often used (14) . A higher dose rate/fraction, the use of small diameter molds (< 20 mm), and the length of vagina irradiated can all contribute to stenosis (14,15) .…”

Australian high‐dose‐rate brachytherapy protocols for gynaecological malignancy

“…External beam radiotherapy followed by HDR brachytherapy caused more toxicity than HDR brachytherapy alone as adjuvant therapy for endometrial cancer, which was statistically significant 16 . Interestingly, patients who had pelvic lymphadenectomy (LAD) and external beam radiotherapy had more toxicity than patients who did not have a LAD.…”

Severe Vaginal Stenosis Simulating a Transverse Septum with Huge Hematocolpos in an Hiv-patient: How to Make a Break in the Wall?

“…Most of vaginal shortening are reported as a late consequence of severe vaginal infections, and as being greater for women with cervical cancer, endometrial cancer, and in those undergoing radiotherapy [8][9][10].…”