title: The impact of a vaginal brachytherapy boost to pelvic radiation in stage III endometrial cancer.
abstract: OBJECTIVE
  We investigate the use and impact of a vaginal brachytherapy boost (VBB) after pelvic radiotherapy for stage III endometrial adenocarcinoma on vaginal and pelvic control.
  
  
  METHODS
  One hundred patients treated from 1998-2011 with surgery and adjuvant therapy with or without a VBB were included. Variables examined were grade, stage, lymphovascular space invasion (LVSI), vaginal involvement (VI), cervical stromal involvement (CSI), myometrial invasion (MI), and a VBB. Failure was scored as vaginal, or pelvic. Fisher's exact test assessed association between variables with vaginal and pelvic control.
  
  
  RESULTS
  With a median follow up of 43 months, 31% were stage IIIA, 6% stage IIIB, and 63% stage IIIC. Thirty-eight (38%) received pelvic radiotherapy alone, and 62% received adjuvant chemotherapy. Of the 100 patients, 82 were treated with a VBB, 10 were not treated with a VBB, and 8 were not treated with RT. Of the 82 patients who received a VBB, 5 failed in the vagina with vaginal and pelvic control rates of 94% and 92%. The impact of VB reached borderline significance with its impact on pelvic control, 92% vs. 70% (p = 0.056), and did not affect vaginal control, 94% and 90% (p = 0.50). Neither tumor grade, LVSI, CSI, stage, nor LVSI (p > 0.05) statistically significantly impacted vaginal control.
  
  
  CONCLUSIONS
  There are no clinical guidelines for the use of a VBB in stage III endometrial cancer. The majority of our patients were treated with a VBB and experienced excellent pelvic and vaginal control. The presence of traditional adverse features did not negatively impact control in our patient cohort. However, the role of a VBB needs further investigation to understand the incremental benefit beyond pelvic RT.
authors.affiliation: Department of Radiation Oncology, UC Davis Cancer Center, University of California Davis, Sacramento, CA.
authors.forename: Adam
authors.initials: A
authors.lastname: Huddleston
authors.affiliation: Department of Radiation Oncology, UC Davis Cancer Center, University of California Davis, Sacramento, CA.
authors.forename: Sally
authors.initials: S
authors.lastname: Zhen
authors.affiliation: Department of Public Health Sciences, Division of Biostatics, University of California Davis, Sacramento, CA.
authors.forename: Lihong
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Radiation Oncology, UC Davis Cancer Center, University of California Davis, Sacramento, CA.
authors.forename: Dominique
authors.initials: D
authors.lastname: Rash
authors.affiliation: Department of Gynecology Oncology, University of California Davis, Sacramento, CA, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Leiserowitz
authors.affiliation: Department of Radiation Oncology, UC Davis Cancer Center, University of California Davis, Sacramento, CA.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Mayadev
keywords: endometrial cancer; pelvic radiation therapy; vaginal brachytherapy