title: Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients.
abstract: OBJECTIVE
  To analyze the vaginal-cuff local control (VCC) and toxicity in postoperative endometrial carcinoma patients (EC) underwent high-dose-rate brachytherapy (HDR-BT) administered daily.
  
  
  METHODS
  154 consecutive patients received postoperative HDR-BT for EC from January 2007 to September 2011. FIGO-staging I-IIIC2 patients were divided into two groups according to risk classification: Group 1 (94/154) included high-risk or advanced disease patients and Group 2 (60/154) included intermediate-risk EC patients. Group 1 underwent external beam irradiation (EBI) plus HDR-BT (2 fractions of 5 Gy) and Group 2 underwent HDR-BT alone (4 fractions of 5 Gy). Toxicity evaluation was done with RTOG scores for bladder and rectum, and the objective criteria of LENT-SOMA for vagina.
  
  
  RESULTS
  With a median follow-up of 46.7 months (36.6-61 months) only two patients developed vaginal-cuff recurrence in Group 1 (2.1 %) and none in group 2 (0 %). Early toxicity in Group 1 appeared 5.3 % in rectum, 7.5 % in bladder (G1-G2) and 2.1 % in vagina (G1); late toxicity was present in 7.3 % in rectum (all G1-G2 but 1 G3) and in 27.7 % in vagina (all G1-G2 but one G4). In Group 2, 6.7 % developed acute G1-G2 bladder and 6.6 % acute vaginal (G1-G2) toxicity. No late rectal or bladder toxicity was observed; 21.7 % of G1-G2 presented late problems in vagina.
  
  
  CONCLUSIONS
  The present HDR-BT schedule of 2 fractions of 5 Gy after EBI and 4 fractions of 5 Gy administered daily showed excellent results in terms of VCC and toxicity.
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain. ivanriosh@gmail.com.|Radiation Oncology Department, Cancer Institute, Centro Medico Imbanaco, Cali, Colombia. ivanriosh@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Ríos
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rovirosa
authors.affiliation: Public and Health Department, Medicine Faculty, Universitat de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ascaso
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Valduvieco
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Herreros
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Castilla
authors.affiliation: Radiation Oncology Department, Hospital General de Albacete, Albacete, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Sabater
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain.
authors.forename: K
authors.initials: K
authors.lastname: Holub
authors.affiliation: Gynecological Surgery, Functional Gynecologic Cancer Unit, Hospital Clinic I Universitari, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pahisa
authors.affiliation: Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer Unit, Hospital Clinic Universitari, C/Villarroel no. 170, 08036, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Biete
authors.affiliation: Radiation Oncology Department, Hospital Sant Joan de Reus, Tarragona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Arenas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D014621:Vagina / Q000473:pathology / Q000528:radiation effects
keywords: Brachytherapy schedules; Endometrial cancer; Endometrial cancer adjuvant treatment; Gynecologic brachytherapy