title: The management of inoperable Stage I endometrial cancer using intracavitary brachytherapy alone: a 20-year institutional review.
abstract: OBJECTIVE
  To review our institution's results with primary low dose rate (LDR) intracavitary brachytherapy using Heyman's capsules for medically inoperable cancer of the endometrium.
  
  
  METHODS
  The study was a retrospective review of inoperable early-stage endometrial cancer patients at the Cross Cancer Institute in Edmonton, Canada, treated with primary radiotherapy from January 10, 1986 to July 17, 2006. Forty-four patients with International Federation of Gynaecology and Obstetrics (FIGO) clinical Stage I disease were included in the study. Kaplan-Meier survival analysis was performed to obtain estimates of overall survival (OS), disease-free survival, and disease-specific survival (DSS). Tumor grade was assessed as a potential predictor of OS by comparing survival curves using a log-rank test.
  
  
  RESULTS
  The median OS time was 75.5 months (95% confidence interval 55.6-95.3 months). For the entire group, the 5- and 10-year OS was 60.5% and 24.0%, respectively. The 5- and 10-year DSS was 87.7% and 79.7%, respectively. For a subset treated as planned, the 5- and 10-year OS was 54.5% and 34.5%, respectively. The 5- and 10-year DSS was 83.0% and 76.4%, respectively. When stratified by grade, trends in survival analysis are inversely related to grade. Both the trend analysis and the log-rank test were statistically significant at a p<0.05 level.
  
  
  CONCLUSIONS
  Our experience with LDR brachytherapy for the treatment of Stage I endometrial cancer is comparable to surgical treatment and to results reported in the literature for high dose rate brachytherapy. Further study that would help define the indications for a primary radiotherapeutic approach in early-stage endometrial cancer may lower current thresholds for recommending primary radiotherapy versus surgery.
authors.affiliation: Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada. careys@ualberta.ca
authors.forename: Carey B
authors.initials: CB
authors.lastname: Shenfield
authors.forename: Robert G
authors.initials: RG
authors.lastname: Pearcey
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: George S
authors.initials: GS
authors.lastname: Dundas
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013997:Time Factors