title: High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma.
abstract: OBJECTIVE
  To evaluate our institutional experience combining carboplatin-paclitaxel (C/T) chemotherapy with high-dose-rate (HDR) intra-vaginal brachytherapy (IVB) following comprehensive surgical staging in localized uterine serous carcinoma (USC).
  
  
  METHODS
  Institutional chart review identified 56 patients with FIGO 2009 stage I-II USC treated between 2000-2010. Patients underwent total hysterectomy, bilateral salpingo-oopherectomy, and comprehensive surgical staging including pelvic and para-aortic lymph node dissection, omentectomy, and peritoneal cytology. Chemotherapy was 6 cycles of C/T, and the IVB dose was 14 Gy in 2 fractions, prescribed to 0.5 cm from the cylinder surface. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  The median follow-up time was 49 months (range: 9-145). The 5-yr RFS and OS were 85% and 93%, respectively. In all cases of recurrence (n = 8), the first site of failure was extra-pelvic. There were no isolated vaginal recurrences, however, there was one vaginal apex recurrence recorded at 19 months in a patient with simultaneous lung metastases. Thus, the 2-year vaginal RFS was 98%.
  
  
  CONCLUSIONS
  Excellent vaginal/pelvic control rates were observed. Further study of HDR brachytherapy dose and fractionation in combination with chemotherapy is worthwhile.
authors.affiliation: Department of Therapeutic Radiology.
authors.forename: Shari
authors.initials: S
authors.lastname: Damast
authors.affiliation: Department of Therapeutic Radiology.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Higgins
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratner
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Maria C
authors.initials: MC
authors.lastname: De Leon
authors.affiliation: Department of Therapeutic Radiology.
authors.forename: Sheida
authors.initials: S
authors.lastname: Mani
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Santin
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutherford
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Schwartz
keywords: brachytherapy; chemotherapy; endometrial cancer; papillary serous
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