High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer

The objective of this study was to determine the efficacy of high-dose-rate (HDR) brachytherapy in 36 medically inoperable patients with stage I endometrial cancer.

From October 1989 to August 1997, 36 patients presented with clinical stage I inoperable endometrial cancer. Surgery was precluded because of obesity and/or poor cardio-pulmonary reserve. Obesity was assessed using the body mass index (BMI) scale (kg/m2). Patients received 5 weekly HDR outpatient brachytherapy applications while under intravenous conscious sedation. Three-year clinical endpoints were calculated using the Kaplan and Meier method. Grade 3 and above complications were scored using the Radiation Therapy Oncology Group system.

The median age, Karnofsky performance status, BMI, and weight were 65 years old, 80%, 47 kg/m2, and 268 lbs, respectively. Nineteen patients were inoperable due to morbid obesity (median weight and BMI: 316 lbs and 56 kg/m2) while the remaining patients had other significant medical problems. Two patients died from acute cardiovascular events within 30 days of the last insertion. With a median follow-up of 32 months the 3-year uterine control, disease-free survival, survival, and complications were 88, 85, 65, and 21%, respectively.

Excellent uterine control rates (88%) were achieved using HDR brachytherapy for patients with medically inoperable endometrial cancer, but with significant acute and late morbidities. These toxicities were observed in a previous interim analysis that resulted in major modifications of the HDR program. No severe complications have developed since these changes were implemented. The current approach used for these challenging inoperable patients is a viable alternative to observation or hormonal therapy.