Simulation-free vaginal cuff brachytherapy for high-intermediate risk endometrial cancer

Area of Science:

• Oncology
• Radiation Oncology
• Gynecologic Oncology

Background:

• Vaginal brachytherapy (VBT) is a standard treatment for high-intermediate risk (HIR) endometrial cancer (EC).
• Simulation is often used to verify applicator placement during VBT.
• The necessity of simulation for optimal outcomes in VBT for EC is not fully established.

Purpose of the Study:

• To evaluate vaginal recurrence (VR) outcomes in patients with HIR EC treated with VBT without simulation.
• To compare these outcomes with historical data from the PORTEC-4a trial, which mandated simulation.

Main Methods:

• Retrospective cohort study of 255 women with HIR EC treated with VBT without simulation.
• Analysis of VR using a competing risks framework.
• Comparison of outcomes with the standard brachytherapy arm of the PORTEC-4a trial.

Main Results:

• A total of 255 patients were analyzed with a median follow-up of 60.1 months.
• The 5-year cumulative incidence of VR was 3.6% in the cohort treated without simulation.
• This rate was comparable to the 1.6% 5-year VR incidence reported in the PORTEC-4a trial, with no significant differences observed across subgroups or applicator types.

Conclusions:

• VBT without simulation was associated with low VR rates in patients meeting PORTEC-4a eligibility criteria.
• Omission of simulation may not compromise vaginal control in appropriately selected HIR EC patients.
• Further prospective studies are recommended to evaluate different verification strategies in VBT.