title: External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma: a prospective, randomized study--quality-of-life analysis.
abstract: BACKGROUND
  A combination of vaginal brachytherapy and external beam radiotherapy was compared with brachytherapy alone in medium-risk endometrial carcinomas. Quality-of-life analysis is an important part of a randomized study to find out the optimal adjuvant treatment for this group of patients.
  
  
  OBJECTIVE
  To evaluate the value of adjuvant external beam pelvic radiotherapy in adjunct to vaginal brachytherapy in medium-risk endometrial carcinoma. Quality-of-life evaluation is the main topic of this report.
  
  
  METHODS
  A consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study end points were locoregional recurrences and overall survival. Secondary end points were recurrence-free survival, toxicity, and quality-of-life. European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OV28 modules were used to evaluate global health status, functional scales, and symptom scales.
  
  
  RESULTS
  Five-year locoregional relapse rates were 1.5% after external beam (ERT) plus vaginal irradiation (VBT) and 5% after vaginal irradiation alone (P = 0.013), and 5-year overall survival (OS) rates were 89% and 90%, respectively. External beam radiotherapy was associated with a higher rate of adverse effects from the intestine and the bladder, and quality-of-life parameters deteriorated at the end of radiotherapy but recovered to normal levels within a few months. There was a significant difference in favor of VBT alone with regard to adverse effects of the bowel and urinary tract, and quality-of-life.
  
  
  CONCLUSIONS
  Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded; but increased late toxicity from the intestine and the bladder. External beam irradiation decreased global health status during and after treatment, and 3 functional scale items (physical, role, and social). Six of 11 symptom items showed a pattern favoring vaginal brachytherapy alone.
authors.affiliation: Department of Gynecological Oncology, Örebro University Hospital, Örebro, Sweden. bengt.sorbe@orebroll.se
authors.forename: Bengt Göran
authors.initials: BG
authors.lastname: Sorbe
authors.forename: György
authors.initials: G
authors.lastname: Horvath
authors.forename: Håkan
authors.initials: H
authors.lastname: Andersson
authors.forename: Karin
authors.initials: K
authors.lastname: Boman
authors.forename: Caroline
authors.initials: C
authors.lastname: Lundgren
authors.forename: Birgitta
authors.initials: B
authors.lastname: Pettersson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality*; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate; D014625:Vaginal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery