title: Can we shorten the overall treatment time in postoperative brachytherapy of endometrial carcinoma? Comparison of two brachytherapy schedules.
abstract: OBJECTIVE
  To analyze vaginal-cuff relapses (VCR) and toxicity of two brachytherapy (BT) schedules in postoperative endometrial carcinoma and to correlate vaginal toxicity with vaginal-surface-EQD2Gy3 dose (VS-EQD2Gy3).
  
  
  METHODS
  319 patients (p) I-IIIC-Figo-stage were treated with 2 BT schedules. One schedule included 166p (Group-1) to whom 3 fractions (Fr) of 4-6Gy per week (w) of BT were administered after external beam radiotherapy (EBI) (125p) and 6Fr/2w of 4-6Gy in exclusive-BT (41p). The second schedule included 153p (Group-2) with BT administered daily with 2Fr/w of 5-6Gy after EBI (94p) and 5-6Gy/4Fr/w in exclusive-BT (59p). Doses were prescribed at 5mm from the vaginal surface. Toxicity was evaluated using RTOG scores for the rectum and bladder and objective LENT-SOMA scores for the vagina.
  
  
  METHODS
  Chi-square, Fisher and Student's-t tests.
  
  
  RESULTS
  Mean follow-up (months): Group-1: 66.55 (7.73-115.40), Group-2: 41.49 (3.13-87.90). VCR: Group-1: 3p (1.88%); Group-2: 2p (1.3%). No differences were found between the two schedules comparing rectal (p=0.170), bladder (p=0.125) and vagina (p=0.680) late toxicities and comparing vagina EBI+BTp vs. exclusive-BTp (p=0.667). Significant differences in VS-EQD23Gy were observed considering EBI+BT (Groups 1+2) vs. exclusive-BT (Groups 1+2) (p<0.0001); nevertheless, no association was found between VS-EQD23Gy and vaginal complications.
  
  
  CONCLUSIONS
  No differences were found between the two schedules. No association was found between vaginal toxicity and VS-EQD23Gy. Consequently, treatment with the least number of fractions is preferable.
authors.affiliation: Radiation Oncology Dpt., ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain. Electronic address: rovirosa@clinic.ub.es.
authors.forename: Angeles
authors.initials: A
authors.lastname: Rovirosa
authors.affiliation: Public and Health Dpt., Medicine Faculty, Universitat de Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
authors.affiliation: Radiation Oncology Dpt., Hospital Sant Joan de Reus, Tarragona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arenas
authors.affiliation: Radiation Oncology Dpt., Hospital General de Albacete, Spain.
authors.forename: Sebastia
authors.initials: S
authors.lastname: Sabater
authors.affiliation: Radiation Oncology Dpt., ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Herreros
authors.affiliation: Radiation Oncology Dpt., ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Camarasa
authors.affiliation: Radiation Oncology Dpt., ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain; Radiation Oncology Dpt., Centro Médico Imbanaco, Cali, Colombia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Rios
authors.affiliation: Radiation Oncology Dpt., ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Holub
authors.affiliation: Gynecological Surgery, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Pahisa
authors.affiliation: Radiation Oncology Dpt., ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Biete
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D012007:Rectum / Q000473:pathology; D013997:Time Factors; D001743:Urinary Bladder / Q000473:pathology; D014621:Vagina / Q000473:pathology
keywords: HDR brachytherapy; Postoperative endometrial carcinoma