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Postoperative brachytherapy for endometrial cancer using a ring applicator.

Ben G L Vanneste1, Philip Meijnen2, Chris S J Hammerstein3

  • 1Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, MAASTRO Clinic, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.

Brachytherapy
|December 3, 2014
PubMed
Summary

Postoperative vaginal vault brachytherapy (VBT) using a ring applicator for intermediate-risk endometrial cancer shows a low recurrence rate and survival comparable to the general population. This treatment also presents a very low risk of acute side effects, primarily temporary diarrhea.

Keywords:
Endometrial cancerRing applicatorVaginal brachytherapy

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Area of Science:

  • Gynecologic Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Endometrial cancer treatment often involves surgery followed by adjuvant therapy.
  • High-intermediate risk endometrial cancer necessitates careful consideration of local and distant recurrence risks.
  • Vaginal vault brachytherapy (VBT) is a common adjuvant treatment to reduce vaginal recurrence.

Purpose of the Study:

  • To evaluate the efficacy and toxicity of postoperative vaginal vault brachytherapy (VBT) delivered via a ring applicator.
  • To assess rates of vaginal, pelvic, and distant failures in women with high-intermediate risk endometrial cancer.
  • To determine the acute toxicity profile of this VBT approach.

Main Methods:

  • A cohort of 100 patients with Stage IA/IB intermediate-risk endometrial cancer underwent VBT after hysterectomy and bilateral salpingo-oophorectomy.
  • Patients received either low-dose-rate (30 Gy, n=26) or pulsed-dose-rate (28 Gy, n=74) brachytherapy.
  • Follow-up included assessment of recurrence patterns and acute toxicity.

Main Results:

  • At a median follow-up of 37 months, 6% of patients experienced failures.
  • The 3-year actuarial rate of vaginal recurrence was 2.6%.
  • Acute side effects were minimal, with temporary diarrhea reported in 2% of patients. Five-year overall survival was 84%.

Conclusions:

  • Postoperative VBT with a ring applicator is effective in managing intermediate-risk endometrial cancer.
  • This treatment modality demonstrates a low risk of recurrence and comparable survival rates to the general female population.
  • The approach is associated with a very low incidence of acute treatment-related morbidity.