title: Adjuvant vaginal cuff brachytherapy for high-risk, early stage endometrial cancer.
abstract: OBJECTIVE
  To report outcomes following adjuvant high-dose-rate vaginal brachytherapy (VBT) with or without chemotherapy for high-intermediate risk (HIR) and high-risk, early stage endometrial cancer as defined in Gynecologic Oncology Group trial 0249.
  
  
  METHODS
  From May 2000 to January 2014, 68 women with HIR and high-risk endometrial cancer underwent surgical staging followed by VBT. Median VBT dose was 21 Gy delivered in three fractions prescribed to 0.5 cm depth. Paclitaxel 175 mg/m(2) and carboplatin area under the curve 6 was administered every 21 days in sequence with VBT. Actuarial survival estimates were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Patient demographics included a median age of 66 years (range: 36-91) and stages IA (49%), IB (38%), and II (13%), respectively. Thirty-one (46%) patients had HIR disease with endometrioid histology, and 33 (48%) patients had serous or clear cell histology. Thirty-seven (54%) patients received a median 3 cycles (range: 3-6) of chemotherapy in addition to VBT, and 65 patients (96%) completed all prescribed therapy. During a median follow up of 33.1 months (range: 4.0-161.7), four patients have recurred, including one vaginal recurrence. The 3-year estimates of vaginal, pelvic, and distant recurrences were 1.9%, 2.4%, and 9.1%, respectively. The 3-year rates of disease-free and overall survival were 87.7% and 93.9%, respectively.
  
  
  CONCLUSIONS
  Early outcomes with adjuvant VBT with or without chemotherapy demonstrate high rates of vaginal and pelvic control for women with HIR disease. Early vaginal and pelvic relapses in high-risk patients suggest that pelvic external beam radiotherapy is warranted in this subgroup, but additional data from large phase III trials is warranted.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital.
authors.forename: Harriet Belding
authors.initials: HB
authors.lastname: Eldredge-Hindy
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital.
authors.forename: Gary
authors.initials: G
authors.lastname: Eastwick
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital.
authors.forename: Pramila Rani
authors.initials: PR
authors.lastname: Anne
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Thomas Jefferson University Hospital.
authors.forename: Norman G
authors.initials: NG
authors.lastname: Rosenblum
authors.affiliation: Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, USA.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Schilder
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Thomas Jefferson University Hospital.
authors.forename: Raffi
authors.initials: R
authors.lastname: Chalian
authors.affiliation: Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Zibelli
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Thomas Jefferson University Hospital.
authors.forename: Christine H
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University Hospital.
authors.forename: Robert
authors.initials: R
authors.lastname: Den
keywords: clear cell carcinoma; endometrial cancer; high-dose-rate brachytherapy; high-intermediate risk; papillary serous