Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Abstract

Objective. The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma.Methods. Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death.Results. The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n ‫؍‬ 18), Stage II (n ‫؍‬ 7), and Stage III (n ‫؍‬ 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingooophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n ‫؍‬ 5) or at distant sites (n ‫؍‬ 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n ‫؍‬ 2), fistula (n ‫؍‬ 2), and radiation stricture (n ‫؍‬ 1).Conclusion. Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.

Ultraschallgestützte interstitielle Brachytherapie in der Behandlung fortgeschrittener vaginaler Rezidive von Zervix- und Korpuskarzinomen

“…In our series all stage III tumors were large tumors (≥ 5 cm) what also could explain the bad outcome of these patients. Time to relapse was a significant prognostic factor in our series and in series concerning surgical treatment but not in other series concerning radiotherapy [5,22,43]. Both in our series and in the series of Ito et al no significant differences were found between brachytherapy alone and combined brachytherapy and EBT, while Virostek et al reported treatment modality and total dose as prognostic factors [22,44].…”

“…The use of fluoroscopy or CT-assisted guidance or open MRI necessitates more expensive infrastructure while laparotomy-or laparoscopy-aided implantation of brachytherapy tubes requires intensive cooperation with surgeons [7,8,33,40,43].…”

“…This is comparable to local control of 55-100% and overall survival of 56-77% reported for Table 4. Literature analysis of interstitial brachytherapy in gynecologic malignancies, mostly recurrent tumors [3,7,23,26,31,43]. LDR: low-dose-rate; PDR: pulsed-dose-rate; EBT: external-beam therapy.…”

“…Literaturanalyse bezüglich interstitieller Brachytherapie bei gynäkologischen Tumoren, zumeist Rezidiven [3,7,23,26,31,43]. [26] interstitial series of infiltrating vaginal recurrences using total doses up to 80 Gy.…”

“…There are no generally accepted selection criteria and appropriate application techniques, dose, and fractionation are not well defined, although some series have been published recently [3,7,23,26,31,43]. Starting with freehand applications, numerous techniques with regard to different transperineal templates, different brachytherapy modalities including low-dose-rate (LDR), high-dose-rate (HDR), pulsed-dose-rate (PDR), and permanent implants and different guidance methods including computed tomography (CT), magnetic resonance imaging (MRI), and fluoroscopy have been developed during the last decades [1, 4, 7, 8, 11, 14, 20, 21, 23-25, 29, 30, 33, 40-43].…”