title: Vaginal brachytherapy for early stage uterine papillary serous and clear cell endometrial cancer.
abstract: OBJECTIVE
  To report clinical outcomes following adjuvant high-dose-rate (HDR) vaginal brachytherapy (VB) for early-stage uterine papillary serous (UPSC) and clear cell (CC) endometrial cancer.
  
  
  METHODS
  A retrospective study of Stage I and II papillary serous and clear cell endometrial cancer treated with post-operative HDR VB between October 2005 and May 2012 was performed. A total of 37 patients were identified, 26 with UPSC, 9 with CC and 2 with mixed UPSC/CC. After total hysterectomy and bilateral salpingo-oophorectomy, VB was administered without external-beam radiation with a dose of 24 Gy in 6 fractions prescribed to the vaginal surface. Chemotherapy was given to 30 patients (75%).
  
  
  RESULTS
  The median follow up time was 24.8 months (range, 2.0 to 71.5 months). Four patients relapsed, 2 with UPSC and 2 with CC. The initial site of relapse was concurrent vagina, pelvic/para-aortic nodes and abdominal wall (1), pelvic/para-aortic nodes (1) and para-aortic nodes alone (2). The 2-year vaginal-control rate was 96.8%. The pelvic-control rate including vaginal and nodal relapse was 93.5%. The 2-year disease-free and overall survival rates were 89.3% and 100%, respectively.
  
  
  CONCLUSIONS
  HDR VB as the sole adjuvant treatment modality for early-stage UPSC/CC is associated with a low rate of vaginal relapse and excellent survival outcomes. This novel low-dose regimen for VB is safe and effective.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Kanokpis
authors.initials: K
authors.lastname: Townamchai
authors.forename: Ross
authors.initials: R
authors.lastname: Berkowitz
authors.forename: Mandar
authors.initials: M
authors.lastname: Bhagwat
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Damato
authors.forename: Scott
authors.initials: S
authors.lastname: Friesen
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.forename: Ursula
authors.initials: U
authors.lastname: Matulonis
authors.forename: Desmond
authors.initials: D
authors.lastname: O'Farrell
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018283:Cystadenocarcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D014621:Vagina