Definitive salvage for vaginal recurrence of endometrial cancer: The impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification

Vargo, John A.; Kim, Hayeon; Houser, Christopher J.; Berhane, Hebist; Sukumvanich, Paniti; Olawaiye, Alexander; Kelley, Joseph L.; Edwards, Robert P.; Comerci, John T.; Huang, Marilyn; Courtney‐Brooks, Madeleine; Beriwal, Sushil

doi:10.1016/j.radonc.2014.08.038

Cited by 44 publications

(31 citation statements)

References 27 publications

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“…Among the few studies that have looked at HDR-BT for vaginal recurrent EC, Petignat et al (17), Vargo et al (4), Vance et al (23), Lin et al (2) and Fokdal (39) showed comparable local control, progression-free, and overall survival rates. Petignat et al reported 5-year LC and DFS rates of 100% and 96%, respectively; for patients treated with HDR-BT for isolated vaginal recurrence of FIGO stage I EC.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Endometrial cancer is the most common gynecologic malignancy in the United States (1–4). Approximately 80% of patients with EC present with early-stage disease and undergo a total hysterectomy plus bilateral salpingo-oophorectomy (5–9).…”

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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“…Brachytherapy, which is associated with less toxicity, may be sufficient to prevent vaginal relapse in some patients. 12 The recently released ESGO guidelines 9,10 still recommend administration of RT despite the lack of benefit for survival and regard brachytherapy as an alternative for node-negative high-risk stage I and selected stage II patients. Our rates of vaginal/pelvic recurrence of 3% in stage I and 8% in stage IIIC after chemotherapy were low compared with these reports.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Patients With High-Risk Endometrial Carcinoma After Treatment With Chemotherapy Only

Smogeli

Cvancarova

Wang

et al. 2018

Int J Gynecol Cancer

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ObjectivesAdjuvant treatment of high-risk endometrial cancer (EC) is still controversial. Several studies have tried to clarify the best treatment strategy, and guidelines have been made, but no study to date has shown a survival benefit for radiation over chemotherapy. We aimed to evaluate the outcome of high-risk EC patients treated with adjuvant chemotherapy only in a population where the routine administration of adjuvant radiotherapy was omitted.MethodsThis is a retrospective study including 230 EC patients with International Federation of Gynecology and Obstetrics stage I type II, stage Ib type I/G3, stage II, and IIIc treated at Oslo University Hospital between 2005 and 2012. Standard treatment was hysterectomy, bilateral salpingo-oophorectomy and at least pelvic lymphadenectomy followed by adjuvant chemotherapy.ResultsOf the 230 high-risk patients, standard treatment was given to 146 patients (63.5%): 60 patients in stage I, 10 patients in stage II, and 76 patients in stage IIIc. Only 10% of patients with stage I disease relapsed, with 3.3% locoregional relapses and 6.7% distant relapses. Recurrence rate in stage IIIc was 39.5%, with 7.9% isolated vaginal and 31.6% distant relapses. The 3-year disease-free survival was 92% for stage I, 80% for stage II, and 60% for stage IIIc disease. In the total population, 55 patients had International Federation of Gynecology and Obstetrics stage Ia, 43 Ib, 42 stage II, and 90 stage IIIc disease. Recurrence rate in the total population was 29.6%, with 9.6% isolated vaginal recurrences, 1.7% recurrences located in the pelvis, and 18.3% distant recurrences.ConclusionsPatients with high-risk EC have acceptable vaginal/pelvic control rates after adjuvant chemotherapy. However, prognosis remains poor for patients with stage IIIc disease, also after chemotherapy.

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“…There is currently no evidence to suggest that modern techniques of image-guided brachytherapy and intensitymodulated radiotherapy (IMRT) are superior to conventional approaches, although a single institution retrospective study of RT (EBRT predominantly using an IMRT technique followed by image-guided high dose rate [HDR] brachytherapy) for vaginal recurrence has also reported high tumour control rates. 172 Recommendation 10 …”

Section: Rt For Isolated Vaginal Relapse In Early-stage Endometrial Cmentioning

confidence: 99%

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up

Colombo

Creutzberg

Amant³

et al. 2016

Int J Gynecol Cancer

601

569

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Definitive salvage for vaginal recurrence of endometrial cancer: The impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification

Cited by 44 publications

References 27 publications

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

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

Clinical Outcome of Patients With High-Risk Endometrial Carcinoma After Treatment With Chemotherapy Only

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up

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