The efficacy of postoperative vaginal irradiation in preventing vaginal recurrence in endometrial cancer

Abstract

Between 1960 and 1985 hysterectomy was performed on 811 FIGO stage I and 116 stage II endometrial cancers which were divided into three groups: low-risk stage Ii (grade 1 and 2 lesions confined to the inner third of the myometrium; high-risk stage Iii (grade 3 and/or invading to the middle third of the myometrium or beyond); and FIGO stage II tumors (also high-risk). Hysterectomy was the only treatment in 492; in 145 the vaginal vault alone was radiated and in 290 the whole vagina, in each instance by an intracavity dose of 60Gy; in 34 of the latter high-risk tumors the pelvis received an additional 46Gy by external beam therapy. Forty isolated vaginal recurrences were detected; 10 in 308 low-risk and 22 in 184 high-risk tumors treated by surgery alone, and two and five in 40 low and 105 high-risk patients, respectively, who received adjuvant vault irradiation. No recurrences followed irradiation of the whole vaginal mucosa in 163 stage Ii low-risk and 40 stage II lesions and one, 9 years later, in 87 high-risk stage Iii tumors. Nearly 45% of patients with vaginal recurrence died from cancer within 1 year, 77% within 5 years and only 10% survived their recurrence 10 years. Total vaginal irradiation eliminated vaginal recurrences in low risk and reduced the incidence to 2.1% at 20 years after high-risk tumors.

Morbidity of adjuvant high-dose-rate brachytherapy for low to intermediate risk endometrial adenocarcinoma completely resected

“…Our results were comparable with those of other centers and, as in other series, the most important prognostic factors tended to be the tumor grade and depth of myometrial invasion [6,9,[12][13][14]. There was a trend toward an association between the final BED for rectal tissue and late complications, but without statistical significance.…”

“…The most common location of recurrence is at the vaginal apex, with a relative frequency of 4:1 [6,9].…”

“…In Brazil, cancer of the uterine corpus is the second most common cancer in the female pelvis and unlike the most common malignancy, cervical cancer, its incidence is rising [2]. Recurrence patterns of endometrial neoplasia can be predicted based on pathological parameters, with recurrence rates in the vaginal cuff ranging from 3% to 15% when surgery is performed with no adjuvant therapy [3][4][5][6]. High-dose-rate brachytherapy (HDR-B) has become an acceptable treatment for carcinoma of the cervix in combination with external beam therapy and has been used clinically for many years.…”

Is Modified Radical Hysterectomy Needed for Patients with Clinical Stage I/II Endometrial Cancers? A Historical Control Study

“…In clinical stage I, approximately 5-20% of patients who were treated with TAH and bilateral salpingo-oophorectomy alone develop vaginal and pelvic recurrences, which were associated with deep myometrial invasion, undifferentiated tumors, lymphovascular space invasion and advanced stage [7,8,9,10,11,12,13]. …”

Cisplatin and Concomitant Radiotherapy Followed by Chemotherapy.Towards an Optimal Adjuvant Therapy Protocol for High-risk Endometrial Cancer Patients

“…Therapeutic modalities include the use of vault brachytherapy (vaginal cylinders), standard external pelvic and/or extended field irradiation and intensity modulated radiotherapy. The incidence of major complications after radiotherapy approaches 4-5% and can be even higher following transperitoneal lymphadenectomies [6].…”