title: Perineal template interstitial brachytherapy salvage for recurrent endometrial adenocarcinoma metastatic to the vagina.
abstract: OBJECTIVE
  To evaluate the use of interstitial brachytherapy salvage of recurrent endometrial adenocarcinoma metastatic to the vagina.
  
  
  METHODS
  From September 1989 to February 1995, 15 patients with locally recurrent endometrial adenocarcinoma were treated with perineal template interstitial irradiation with low-dose-rate brachytherapy 192Ir/137Cs. Five of the 7 previously unirradiated patients received pelvic external beam radiation therapy (EBRT) of 45-50 Gy, with standard fractionation followed by an interstitial brachytherapy boost dose of 30 Gy (range 25 to 35 Gy). The other 2 patients received only brachytherapy of 40 Gy (palliative) and 50 Gy. Eight previously irradiated patients received only brachytherapy of 50 to 55 Gy.
  
  
  RESULTS
  After a median follow-up of 47 months (range 14-81), the actuarial local control rate was 66.6%. The local control rate for patients treated with interstitial irradiation only was 64.3% and the local control rate for patients treated with interstitial irradiation + EBRT was 100%. Distant metastases occurred in 30.7% of the patients. Actuarial overall and disease-specific 5-year survival were 42.3 and 67.5%, respectively. Toxicity has been minimal, with 6 patients complaining of vaginal/rectal (RTOG) grade 1-3 complications (5 patients grade 1-2, 1 patient grade 3).
  
  
  CONCLUSIONS
  These results suggest that perineal template interstitial irradiation (if possible with supplementary EBRT) is an effective alternative to radical or exenterative pelvic surgery for locally recurrent endometrial cancer. Excellent survival and local control rates can be achieved with low morbidity, especially if EBRT is added.
authors.affiliation: Division of Radiation Oncology, Arthur G. James Cancer Hospital & Research Institute, Ohio State University, Columbus 43210, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nag
authors.forename: R
authors.initials: R
authors.lastname: Martínez-Monge
authors.forename: L J
authors.initials: LJ
authors.lastname: Copeland
authors.forename: L
authors.initials: L
authors.lastname: Vacarello
authors.forename: G S
authors.initials: GS
authors.lastname: Lewandowski
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy*; D010502:Perineum / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D016019:Survival Analysis; D014625:Vaginal Neoplasms / Q000532:radiotherapy* / Q000556:secondary*