High-dose rate brachytherapy for Stage I/II papillary serous or clear cell endometrial cancer.
OBJECTIVE
To determine the efficacy of high-dose rate brachytherapy as adjuvant treatment for Stage I/II papillary serous or clear cell endometrial cancer.


METHODS
A retrospective study of all patients with Stage I/II papillary serous or clear cell endometrial cancer treated with high-dose rate brachytherapy between 1995 and 2001 was performed. Following surgical staging, which included hysterectomy with pelvic and aortic lymphadenectomy, all patients without extrauterine disease were treated with high-dose rate brachytherapy and followed for recurrence. The locations of recurrences were noted and were classified as local or distant.


RESULTS
Three (13%) recurrences occurred among 24 patients with Stage I/II papillary serous or clear cell carcinoma. The risk of recurrence was similar for papillary serous and clear cell cancer (12% vs. 12%). Local control was achieved in 96%. The risk of recurrence for those with no myometrial invasion, less than 1/2, or more than 1/2 myometrial invasion was 0%, 10%, and 50%, respectively (P < 0.04). Two of the three recurrences were distant and all patients with recurrence died despite additional treatment.


CONCLUSIONS
High-dose rate brachytherapy (HDR) as the sole adjuvant treatment of Stage I/II papillary serous or clear cell carcinoma is associated with a 13% risk of recurrence. Although local control with HDR is excellent, the risk of distant recurrence is increased with deep myometrial invasion. High-dose rate brachytherapy is adequate for Stage IA cases, but more aggressive treatment combining chemotherapy with HDR should be evaluated for more advanced Stage I/II cases.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Center, University of Rochester School of Medicine, 125 Lattimore Road, Rochester, NY 14620, USA. Brent_DuBeshter@urmc.rochester.edu
Brent
B
DuBeshter
Kim
K
Estler
Kim
K
Altobelli
Sandra
S
McDonald
Christopher
C
Glantz
Cynthia
C
Angel
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018283:Cystadenocarcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy*; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012189:Retrospective Studies
D007496:Iridium Radioisotopes; D019275:Radiopharmaceuticals