title: Recurrences and toxicity after adjuvant vaginal brachytherapy in Stage I-II endometrial cancer: A monoinstitutional experience.
abstract: OBJECTIVE
  To evaluate the incidences of vaginal recurrence and toxicity after vaginal brachytherapy in Stage I-II endometrial cancer.
  
  
  METHODS
  Between 2003 and 2012, 150 high-intermediate-risk Stage I and 7 Stage II patients, median age 64 years, underwent surgery, with or without lymphadenectomy, and 3D brachytherapy: 7 Gy, at 5 mm depth from applicator surface, for 3-week fractions. The effects of age, grading, number of excised lymph nodes and pathologic stage on loco-regional relapse (LRR), metastases, and tumor-related death were investigated. Vaginal toxicity was evaluated during followup visits.
  
  
  RESULTS
  At 83 months of median followup, 144 patients were disease free, 2 in relapse, 7 deceased from disease, and 4 from other causes. One vaginal (0.6%), five nodal (3.2%), three pelvic over the vaginal cuff (1.9%), and one distant recurrences were seen (0.6%). The 5-year probability of LRR-free, distant metastasis-free and cause-specific survivals for all patients were 93.6% (95% confidence interval [CI]: 88.1-96.7), 97.8% (95% CI: 93.2-99.3), and 96.5% (95% CI: 93.5-99.5) and for Stage I 95.7% (95% CI: 92.2-9.1), 99.3% (95% CI: 98.0-100), and 97.7% (95% CI: 95.2-100), respectively. At multivariate analysis, Stage II disease and more than 12 lymph nodes sampled were associated with LRR (hazard ratio [HR]: 3.88; 95% CI: 1.390-10.878; p = 0.010 and HR: 6.952; 95% CI: 1.591-30.385; p = 0.010) and Stage II with metastasis and tumor-related death (HR: 23.057; 95% CI: 2.296-231.485; p = 0.008 and HR: 4.324; 95% CI: 1.223-15.290; p = 0.023). Vaginal acute and chronic toxicity was 16% and 55.4%, respectively, all only Grades 1-2.
  
  
  CONCLUSIONS
  For high-to-intermediate-risk Stage I endometrial cancer, 3D vaginal brachytherapy achieved good local control and low toxicity. In Stage II, patients brachytherapy could be administered after complete surgical staging.
authors.affiliation: Department of Onco-Hemato-Gastroenterological Sciences, Radiation Oncology Section, Santa Maria della Misericordia Hospital, Perugia, Italy. Electronic address: eli.perrucci@libero.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Perrucci
authors.affiliation: Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia, Perugia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Lancellotta
authors.affiliation: Department of Medicine, Endocrine and Metabolic Sciences Section, Internal Medicine, Endocrine and Metabolic Sciences Section, University of Perugia, Perugia, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.affiliation: Department of Medical Physics, Medical Physics Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Zucchetti
authors.affiliation: Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia, Perugia, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mariucci
authors.affiliation: Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia, Perugia, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Montesi
authors.affiliation: Department of Onco-Hemato-Gastroenterological Sciences, Radiation Oncology Section, Santa Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Saccia
authors.affiliation: Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Palumbo
authors.affiliation: Department of Surgical and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aristei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D015996:Survival Rate; D014621:Vagina / Q000528:radiation effects*; D014625:Vaginal Neoplasms
keywords: Brachytherapy; Endometrial cancer; Relapse