title: Toward four-dimensional image-guided adaptive brachytherapy in locally recurrent endometrial cancer.
abstract: OBJECTIVE
  To evaluate clinical outcome and feasibility of a four-dimensional image-guided adaptive brachytherapy concept in patients with locally recurrent endometrial cancer.
  
  
  METHODS
  Forty-three patients with locally recurrent endometrial cancer were included. Treatment consisted of conformal external beam radiotherapy followed by a boost using pulsed-dose-rate brachytherapy (BT). Large tumors were treated with MRI-guided interstitial BT. Small tumors were treated with CT-guided intracavitary BT. The planning aim (total external beam radiotherapy and BT) for high-risk clinical target volume was D90 > 80 Gy, whereas constraints for organs at risk were D2cc ≤ 90 Gy for bladder and D2cc ≤ 70 Gy for rectum, sigmoid, and bowel in terms of equivalent dose in 2 Gy fractions.
  
  
  RESULTS
  Median high-risk clinical target volume was 18 cm(3) (range, 0-91). D90 was 82 Gy (range, 77-88). D2cc to bladder, rectum, and sigmoid were 67 Gy (range, 50-81), 67 Gy (range, 51-77), and 55 Gy (range, 44-68), respectively. Median followup was 30 months (6-88). Two-year local control rate was 92% (standard error [SE], 5). Disease-free survival rate and overall survival rate was 59% (SE, 8) and 78% (SE, 7), respectively. Patients with low- to intermediate-risk for recurrence had a 2-year disease-free survival rate of 72% (SE, 9) compared with 42% (SE, 12) in patients with high risk for recurrence (p = 0.04). Late morbidity Grade 3 was recorded in 5 (12%) patients.
  
  
  CONCLUSIONS
  Four-dimensional image-guided adaptive brachytherapy is feasible in locally recurrent endometrial cancer. Local control rate is good. Systemic control remains a problem in patients with high risk for recurrence.
authors: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: Larfok@rm.dk.
authors: Lars
authors: L
authors: Fokdal
authors: Department of Gynaecology, Aarhus University Hospital, Aarhus, Denmark.
authors: Gitte
authors: G
authors: Ørtoft
authors: Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
authors: Estrid S
authors: ES
authors: Hansen
authors: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Lisbeth
authors: L
authors: Røhl
authors: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Erik Morre
authors: EM
authors: Pedersen
authors: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors: Kari
authors: K
authors: Tanderup
authors: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors: Jacob Christian
authors: JC
authors: Lindegaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Image-guided adaptive brachytherapy; Recurrent endometrial cancer