Post-operative high dose rate brachytherapy in patients with low to intermediate risk endometrial cancer.
OBJECTIVE
This paper investigates the outcome using different dose/fractionation schedules in high dose rate (HDR) post-operative vaginal vault radiotherapy in patients with low to intermediate risk endometrial cancer.


METHODS
The world literature was reviewed and thirteen series were analyzed representing 1800 cases.


RESULTS
A total of 12 vaginal vault recurrences were identified representing an overall vaginal control rate of 99.3%. A wide range of dose fractionation schedules and techniques have been reported. In order to analyze a dose response relationship for tumor control and complications, the biologically effective doses to the tumor and late responding tissues were calculated using the linear quadratic model. A threshold was identified for complications, but not vaginal control. While dose fractionation schedules that delivered a biologically effective dose to the late responding tissues in excess of 100 Gy(3) (LQED=60 Gy) predicted for late complications, dose fractionation schedules that delivered a modest dose to the vaginal surface (50 Gy(10) or LQED=30 Gy) appeared tumoricidal with vaginal control rates of at least 98%.


CONCLUSIONS
By using convenient, modest dose fractionation schedules, HDR vaginal vault - brachytherapy yields very high local control and extremely low morbidity rates.
Pearcey
R G
RG
Department of Oncology, University of Alberta Medical School, Edmonton, Alberta, Canada.
Petereit
D G
DG
D001918:Brachytherapy; D002986:Clinical Trials as Topic; D019583:Dose Fractionation, Radiation; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D016014:Linear Models; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control* / Q000532:radiotherapy; D014625:Vaginal Neoplasms / Q000517:prevention & control* / Q000532:radiotherapy