Vaginal brachytherapy management of stage I and II endometrial cancer

Abstract

Adjuvant radiotherapy is an important component of post-operative therapy for patients with early-stage endometrial cancer. In the past decades, many trials have been conducted to determine the optimal adjuvant treatment strategy, pelvic external beam radiotherapy or vaginal brachytherapy. As a result, vaginal brachytherapy became the treatment of choice for patients with early-stage endometrial cancer at high-intermediate risk, based on clinicopathological risk factors. Vaginal brachytherapy maximizes local control and has only mild side effects with limited impact on quality of life, in comparison with pelvic external beam radiotherapy. The most frequently used treatment schedule is the one which was used in the PORTEC-2 trial (21 Gy in three fractions specified at 5 mm depth) and, whenever available, image-guided brachytherapy should be used. However, the most convenient and effective treatment schedule remains to be established. More recently, the discovery and integration of four molecular classes in the risk assessment of endometrial cancer patients has created new opportunities to prevent over- and undertreatment. The 2021 endometrial cancer guideline of the European Society of Gynaecological Oncology (ESGO), European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) now proposes an integrated risk stratification, in which both clinicopathologic and molecular factors are combined, to direct adjuvant therapy. This rationale is now investigated in multiple prospective trials. This review provides an overview of the rationale and currently recommended and new strategies for vaginal brachytherapy in patients with stage I and II endometrial cancer.

A deep learning‐based 3D Prompt‐nnUnet model for automatic segmentation in brachytherapy of postoperative endometrial carcinoma

“…5 The accurate delineation of target volume using CT-or magnetic resonance (MR) images with a vaginal applicator in situ is so important that it can provide preferred data on dose distribution for treatments and minor acute radiation reactions for patients. 4,6 However, it is a generally challenging problem for clinicians to understand the guidelines and experience that achieve inter-and intraoperator variability. Additionally, manual target contouring is a tedious and laborious work, typically taking more than 20 min, 7,8 which increases the heavy workload on limited time treatment planning.Therefore,computerized autosegmentation has been suggested as an alternative tool to promote the efficiency and repeatability of BT treatment.…”

“…Contemporary BT employs adaptive treatment planning through 3D imaging, presenting benefits over traditional two‐dimensional (2D) imaging strategies 5 . The accurate delineation of target volume using CT‐ or magnetic resonance (MR) images with a vaginal applicator in situ is so important that it can provide preferred data on dose distribution for treatments and minor acute radiation reactions for patients 4,6 . However, it is a generally challenging problem for clinicians to understand the guidelines and experience that achieve inter‐ and intra‐operator variability.…”