Postoperative vaginal cuff irradiation using high dose rate remote afterloading: a phase II clinical protocol

Area of Science:

• Gynecology
• Radiation Oncology
• Oncology

Background:

• Endometrial adenocarcinoma requires effective postoperative treatment to improve survival and prevent recurrence.
• High dose rate (HDR) brachytherapy is an evolving technique for localized cancer treatment.
• International Federation of Gynecology and Obstetrics (FIGO) staging is crucial for treatment stratification.

Purpose of the Study:

• To evaluate the efficacy and safety of a Phase II HDR brachytherapy protocol for postoperative FIGO Stage I endometrial adenocarcinoma.
• To report overall survival, local control rates, and complication profiles in patients treated with HDR vaginal cuff brachytherapy.
• To compare preliminary HDR brachytherapy outcomes with existing low dose rate (LDR) brachytherapy data.

Main Methods:

• A Phase II study involving 63 patients with FIGO Stage I endometrial adenocarcinoma.
• Postoperative HDR brachytherapy using an Iridium-192 remote afterloader.
• Two vaginal cuff treatments of 32.4 Gy in two fractions, delivered 1 week apart, using vaginal ovoids.

Main Results:

• No vaginal cuff recurrences observed in 63 patients at a median follow-up of 1.6 years.
• One regional recurrence (1.6%) occurred, treated successfully with salvage irradiation.
• Vaginal apex fibrosis occurred in 22% of patients, symptomatic in 6.3%; vaginal stenosis in 1.6%.

Conclusions:

• Preliminary results suggest 32.4 Gy in two fractions of HDR vaginal cuff brachytherapy is well-tolerated for early-stage endometrial cancer.
• Local control appears comparable to LDR brachytherapy, warranting further investigation.
• Continued patient accrual and follow-up are necessary to fully assess late morbidity, local control, and overall survival.