title: Postoperative brachytherapy for endometrial cancer using a ring applicator.
abstract: BACKGROUND
  To evaluate the rate of vaginal, pelvic, and distant failures and acute toxicity after postoperative vaginal vault brachytherapy (VBT) delivered by a ring applicator in women with high intermediate-risk endometrial cancer.
  
  
  METHODS
  A total of 100 patients were treated with VBT after a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a Stage IA or IB (International Federation of Gynecology and Obstetrics 2009) intermediate-risk endometrial cancer; 26 patients received 30-Gy low-dose-rate, 74 patients received 28-Gy pulsed-dose-rate brachytherapy.
  
  
  RESULTS
  At a median followup of 37 months (range, 1-107), 6 (6%) patients showed failures. Three patients developed an in-field recurrence in the vaginal vault: 1 was isolate, whereas the other 2 showed simultaneous pelvic and/or distant failure. A fourth patient developed an out-of-field recurrence in the posterior vaginal wall of the proximal half of the vagina, including pelvic and distant failure. Two other patients showed only distant failure. The estimated 3-year actuarial rate of any vaginal recurrence was 2.6% (95% confidence interval, 0-6.3%). The 5-year overall survival was 84%, similar to that in the female Dutch population matched for age and date of diagnosis. The acute side effects were low, consisting mainly of the occurrence of temporary diarrhea (2%).
  
  
  CONCLUSIONS
  Postoperative VBT by a ring applicator results in a low recurrence risk, survival rates comparable with the normal female population, and a very low risk of acute morbidity.
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, MAASTRO Clinic, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands. Electronic address: ben.vanneste@maastro.nl.
authors.forename: Ben G L
authors.initials: BG
authors.lastname: Vanneste
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Meijnen
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Chris S J
authors.initials: CS
authors.lastname: Hammerstein
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Nina
authors.initials: N
authors.lastname: Bijker
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rob M
authors.initials: RM
authors.lastname: van Os
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
authors.affiliation: Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Pieters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation*; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014594:Uterine Neoplasms / Q000532:radiotherapy* / Q000601:surgery
keywords: Endometrial cancer; Ring applicator; Vaginal brachytherapy