One-week vaginal brachytherapy schedule as exclusive adjuvant post-operative treatment in intermediate- and high-intermediate-risk endometrial cancer patients

Abstract

The aim of the study was to report survival outcomes and toxicities incidence by using one-week vaginal brachytherapy (VBT) schedule in intermediate-and high-intermediate-risk endometrial cancer patients. Material and methods: One hundred and eight patients were treated with exclusive high-dose-rate (HDR) brachytherapy short schedule (7 Gy/fraction/every other day/1 week). Acute and late rectal, urinary, and vaginal toxicities were recorded according to radiation therapy oncology group (RTOG) scores and late effects normal tissue task force-subjective, objective, management, analytic (LENT-SOMA) scores, respectively. Overall survival (OS), cause specific survival (CSS), and disease-free survival (DFS) were evaluated. Results: Median follow-up was 44 months (range, 6-117 months). The 5-year OS, CSS, and DFS rates were 92.7%, 96.4%, and 89.5%, respectively. Seven of 108 (6.5%) patients relapsed after a median time of 31 months (range, 5-56 months). Death occurred in 6 patients. Four patients died for intercurrent causes without an evidence of disease. Acute bladder toxicity G1-G2 was reported in 11 of 108 (10%) patients, vaginal toxicity G1-G2 in 6 of 108 (5.5%), and gastrointestinal toxicity was observed in 3 of 108 (3%) patients. Late bladder and gastrointestinal G1 toxicities were reported in 4 of 108 (4%) and 1 of 108 (1%) patients, respectively. Late vaginal toxicity (G1-G2) was recorded in 3 of 108 (3%) cases. No grade 3-4 bladder, vaginal, and gastrointestinal toxicities were noted. Conclusions: Exclusive short course adjuvant VBT is an effective treatment in patients with early-stage endometrial cancer and provides good outcomes in terms of disease local control and DFS, with low rates of toxicity profile.

Quality of life and sexual functioning among endometrial cancer patients treated with one week adjuvant high-dose-rate vaginal brachytherapy schedule

“…Sexual dysfunction in gynecologic cancer is thought to result mainly from adjuvant treatment, such as surgery and/or radiation therapy, although the real impact of these adjuvant treatments on sexual disfunction is not well-defined till now [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. In a series of 101 endometrial patients with stage I-IIIA, sexual dysfunction was recorded in 89% [23].…”

“…Three-dimensional planning was performed after acquisition of CT-based imaging, with 0.25 cm slices for all patients. VBT was delivered to vaginal vault using a Nucletron HDR unit, with iridium-192 source at a dose of 21 Gy given in three fractions of 7 Gy each, three times a week, every other day, prescribed at 0.5 cm depth of vaginal wall and 3 cm in length from the apex [ 26 ]. The protocol was approved by a local ethics committees.…”

Adjuvant vaginal interventional radiotherapy in early-stage non-endometrioid carcinoma of corpus uteri: a systematic review

“…These data are consistent with a recent review, in which authors established that acute endovaginal toxicity may occur in less than 20.6% of cases, while late vaginal toxicity G1-G2 may appear in less than 27.7% and G3-G4 in less than 2% [ 54 ]. Furthermore, limited available evidence suggested that there is no difference in terms of acute and late toxicity between low-dose-rate and high-dose-rate VIRt [ 55 ], or using high-dose-rate VIRt short schedule [ 56 ].…”

Adjuvant vaginal cuff brachytherapy in surgically treated endometrial carcinoma patients – in view of the recent evidence

“…Samples of applied fractionation of exclusive HDR-VBT reported in the literature, and the volume of vagina treated are presented in Table 4 [ 24 , 33 - 38 ]. The shortened overall treatment time of exclusive VBT consisting of 21 Gy total dose at 5 mm in 3 fractions, every other day, for one week, was reported as safe [ 34 ].…”