title: High-dose-rate Rotte "Y" applicator brachytherapy for definitive treatment of medically inoperable endometrial cancer: 10-year results.
abstract: OBJECTIVE
  To assess the intermediate clinical outcomes of medically inoperable patients with endometrial cancer treated with definitive Rotte "Y" applicator high-dose-rate brachytherapy (HDRB) over a 10-year period.
  
  
  METHODS
  Forty-nine inoperable patients were treated with HDRB from 1997 to 2007. Forty three (84%) were markedly obese (body mass index >35 kg/m(2)). Thirty-one patients (63.3%) underwent two-dimensional treatment planning, whereas 18 patients (36.7%) underwent three-dimensional treatment planning. Thirty five of the patients (71.4%) were first treated with external beam radiotherapy (EBRT). For patients receiving EBRT in addition to HDRB, the median Y-applicator dose was 20 Gy in 5 fractions; for patients receiving HDRB alone it was 35 Gy in 5 fractions. All patients received two Y-applicator treatments per day.
  
  
  RESULTS
  Median follow-up time for all patients was 33 months. Acute HDRB toxicities were limited to Grade 1 and 2 occurring in 5 patients. One patient had a myocardial infarction. Four patients had late Grade 2 or 3 toxicity. Three patients had local recurrence (median time to recurrence, 16 months). The 3- and 5-year actuarial cause-specific survival rates were 93% and 87%, respectively; the overall survival rate was 83% and 42%, respectively, at 3 and 5 years.
  
  
  CONCLUSIONS
  Twice-daily HDRB using a Y-applicator is a well-tolerated and efficacious regimen for the definitive treatment of medically inoperable patients with early-stage endometrial cancer. The recent incorporation of three-dimensional treatment planning has the potential to further decrease treatment morbidities.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Zorn
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D019583:Dose Fractionation, Radiation; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D016896:Treatment Outcome