Evaluation of Uterine Brachytherapy as Primary Treatment Option for Elderly Patients with Medically Inoperable Endometrial Cancer—A Single-Center Experience and Review of the Literature

Abstract

We aimed to gain more evidence regarding the feasibility, toxicity, and oncological outcome of primary brachytherapy in patients with medically inoperable endometrial cancer. Thirteen patients receiving primary brachytherapy ± external beam radiotherapy (EBRT) for endometrial cancer due to medical inoperability were identified. The Kaplan–Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and local failure-free survival (LFFS). Univariate outcome analyses were performed using the log-rank test. Peri-interventional complications, acute and chronic toxicities were evaluated. Additionally, we performed a Pubmed search and review of the literature of the last 10 years. Mean age at time of diagnosis was 73.9 years (60.4–87.1 years). Eleven patients were staged FIGO IA/B and one patient each with FIGO IIIA and IIIC. Kaplan–Meier-estimated 2-/5-year LFFS were 76.2%/56.4%, respectively. High grading correlated with a worse LFFS (p = 0.069). Kaplan–Meier-estimated 2-/5-year PFS were 76.9%/53.8% and 2-/5-year-OS were 76.9%/69.2%, respectively. No acute toxicities > grade II and only two late toxicities grade II/III occurred. We observed three peri-interventional complications. The available evidence suggests high rates of local control after definitive brachytherapy for inoperable endometrial cancer with a favorable toxicity profile. Definitive brachytherapy +/− EBRT should be considered as the preferred approach for this patient group.

Overall and cancer specific survival following radical or adjuvant (chemo)radiotherapy in a retrospective cohort of elderly patients with endometrial cancer

“…For women with stage 1A grade 1 or 2 endometrioid endometrial cancer, brachytherapy alone has been shown to produce excellent results [14,21] and is an attractive alternative to a prolonged and potentially toxic course of combined treatment, especially if life expectancy is thought to be reduced. What is more, some institutions have developed protocols that utilise local anaesthetic/sedation only [22]. It is notable that all 5 deaths within 30 days of radiotherapy occurred in this group, 4/5 aged ≥80 years, suggesting poorer tolerance to pelvic radiotherapy in very elderly women.…”

Radiation therapy in the definitive management of medically inoperable endometrial cancer

“…In the 2D era, reported rates of local control were in the 75–85% range at 5 years,5 14 25 31–33 with severe late toxicity (grade 3 or 4) observed in up to 20% of patients 32 33. In the 3D era, excellent rates of local control have been reported of 85–90% at 2–3 years, with the majority of published series reporting no rates of severe late toxicity, and only a few series reporting a few isolated cases (<10%) of grade 3 or 4 events 14 23 25 27 28 34–42. Direct comparison of published series is limited due to heterogeneity of patient populations and treatment techniques.…”

“…Direct comparison of published series is limited due to heterogeneity of patient populations and treatment techniques. High-grade endometrioid disease, clear cell and serous papillary histology, as well as higher disease stage are factors that have been associated with higher rates of local failure and all-failure in multiple series 14 25 36 38 40. A summary of published experiences using 3D image-based treatment planning with either CT and/or MRI is shown in Table 3.…”

Stages I–III Inoperable Endometrial Carcinoma: A Retrospective Analysis by the Gynaecological Cancer GEC-ESTRO Working Group of Patients Treated with External Beam Irradiation and 3D-Image Guided Brachytherapy

“…In the United States, 51,065 cases were diagnosed in 2020, with an expected increase up to 125,922 new cases in 2040 [1]. The main treatment is surgery ± radiotherapy ± chemotherapy, but about 10% of early-stage ECs are inoperable due to the body mass index (BMI), age-associated diseases, or anaesthetic contraindications [2][3][4]. Palliative approaches, such as hormone treatment, external beam irradiation (EBRT), and sometimes chemotherapy, have been described in the literature [3].…”