Adjuvant vaginal high-dose-rate afterloading alone in endometrial carcinoma: patterns of relapse and side effects following low-dose therapy.
OBJECTIVE
This retrospective study was conducted to document the incidence and location of recurrences as well as the rate of side effects following low-dose postoperative high-dose-rate (HDR) brachytherapy in patients with endometrial carcinoma.


METHODS
From 1987 to 1993, 122 patients with moderate-risk (78) and high-risk (44) endometrial carcinoma underwent adjuvant vaginal irradiation. All patients received three fractions of 7 Gy specified on the surface of the vaginal cylinder.


RESULTS
Relapses occurred in 12 (9. 8%) patients on average after 25.6 months. Seven (5.7%) patients had a sole pelvic recurrence; in 2 (1.6%) of those the relapse was located in the vagina only. Three (2.5%) patients had a pelvic relapse combined with distant metastases. Distant metastases alone were diagnosed in 2 (1.6%) patients. A tumor recurrence was diagnosed in 3 of 78 (3.8%) patients with moderate-risk disease and in 9 of 44 (20.5%) patients with high-risk disease. The estimated 5-year relapse-free survival was 94% for patients with moderate-risk and 74% for patients with high-risk tumors (P = 0.004). Neither severe nor chronic complications were noted.


CONCLUSIONS
Even low doses of HDR brachytherapy seem sufficient for excellent vaginal disease control in moderate-risk disease. In advanced tumors combined radiation therapy is warranted for improved pelvic disease control.
Department of Radiation Oncology, University of Goettingen, Goettingen, Germany.
E
E
Weiss
P
P
Hirnle
H
H
Arnold-Bofinger
C F
CF
Hess
M
M
Bamberg
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate