Outcomes with image-based interstitial brachytherapy for vaginal cancer.
To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IBBT) for vaginal cancer.



Of 72 patients with vaginal cancer treated with brachytherapy (BT), 47 had image guidance (CT=31, MRI=16) and 25 did not. Kaplan-Meier (KM) estimates were generated for any recurrence, local control (LC), disease-free interval (DFI), and overall survival (OS) and Cox models were used to assess prognostic factors.



Median age was 66 and median follow-up time was 24months. Median cumulative EQD2 dose was 80.8Gy in the non-IBBT group and 77Gy in the IBBT group. For non-IBBT versus IBBT, the 2-year KM LC was 71% vs. 93% (p=0.03); DFI was 54% vs. 86% (p=0.04); and OS 52% vs. 82% (p=0.35). On multivariate analysis, IBBT was associated with better DFI (HR 0.24, 95% CI 0.07-0.73). Having any 2 or more of chemotherapy, high-dose-rate (HDR) BT or IBBT (temporally correlated variables) significantly reduced risk of relapse (HR=0.33, 95% CI=0.13-0.83), compared to having none of these factors.



Over time, the use of chemotherapy, HDR, and IBBT has increased in vaginal cancer. The combination of these factors resulted in the highest rates of disease control. Image-guided brachytherapy for vaginal cancer patients maximizes disease control.
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
Matthias M
MM
Manuel
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
Linda P
LP
Cho
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Department of Biostatistics, Harvard School of Public Health, Boston, USA.
Paul J
PJ
Catalano
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
Antonio L
AL
Damato
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
David T
DT
Miyamoto
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Clare M
CM
Tempany
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Ehud J
EJ
Schmidt
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA. Electronic address: akila@post.harvard.edu.
Akila N
AN
Viswanathan
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*
Brachytherapy; CT; MRI; Radiation; Vaginal cancer