Intravaginal 1-week high-dose-rate brachytherapy alone for Stages I-II endometrial cancer.
OBJECTIVE
To evaluate the feasibility and intermediate-term results of a short course of high-dose-rate (HDR) intravaginal brachytherapy only after hysterectomy.


METHODS
From December 1999 to February 2005, 50 patients with International federation of gynecology and obstetrics Stages IA-IIB endometrioid endometrial adenocarcinoma were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by postoperative HDR brachytherapy alone. The mean age of the patients was 62.6 years (range 42-86). International federation of gynecology and obstetrics patient grouping included IaG3N(x) (n=1), IbG1N(0) (n=1), IbG1N(x) (n=2), IbG2N(0) (n=10), IbG2N(x) (n=20), IbG3N(0) (n=3), IbG3N(x) (n=1), IcG1N(x) (n=2), IcG2N(0) (n=3), IcG3N(0) (n=3), IIaG1N(x) (n=2), IIaG2N(x) (n=1), and IIbG1N(0) (n=1). Twenty-one patients (42.0%) had been surgically staged. Four to 16 weeks after surgery (median 42d, range 28-112), all patients received HDR intravaginal brachytherapy to 25Gy in five consecutive 5-Gy daily fractions prescribed at 0.5-cm depth. Median HDR brachytherapy treatment duration was 5 days (range 5-12).


RESULTS
After a median followup of 37 months (range 12-80), the overall survival and disease-free survival were 96%. No vaginal or pelvic recurrences have been observed. One patient (2%) developed distant metastases. No late toxicities of Grade 3 or greater have been reported.


CONCLUSIONS
The results reported in this study are in agreement with previous reports of postoperative HDR brachytherapy alone in early-stage endometrial cancer. HDR brachytherapy alone seems to provide adequate tumor control. The fractionation schedule proposed (25Gy in five consecutive daily treatments) was well tolerated and is convenient for patients living far from the radiation center.
Department of Oncology, Clínica Universitaria de Navarra, University of Navarre, Avenida Pio XII s/n, E-31080 Pamplona, Navarre, Spain. rmartinezm@unav.es
Rafael
R
Martínez-Monge
Gorka
G
Nagore
Mauricio
M
Cambeiro
Cristina
C
Garrán
Elena
E
Villafranca
Matías
M
Jurado
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010052:Ovariectomy / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina