title: High-dose-rate interstitial brachytherapy for the treatment of high-volume locally recurrent endometrial carcinoma.
abstract: Limited therapeutic options are available for the treatment of locally recurrent endometrial carcinoma. Our objective was to report an institutional experience using interstitial brachytherapy (IBT) to treat significant recurrent endometrial carcinoma, including previously irradiated disease.
  
  
  
  Between December 2004 and September 2012, 40 patients with high-volume locally recurrent endometrial cancer were treated by high-dose-rate IBT (± external beam radiation therapy EBRT). Sixteen patients had prior radiotherapy: EBRT alone (n = 5), intracavitary brachytherapy alone (n = 3), or EBRT with intracavitary brachytherapy boost (n = 8). Actuarial outcome rates were calculated using the Kaplan-Meier method and compared using the log-rank test.
  
  
  
  Median followup interval was 18 months. Median disease-free interval was 61 months. Actuarial local control, progression-free survival (PFS), and overall survival were 74% and 60%, 70% and 51%, and 83% and 72% at 12 and 24 months, respectively. p-Values for local control, progression-free survival, and overall survival between patient who had prior RT (n = 16) to no prior RT (n = 24) were p = 0.38, 0.32, and 0.90, respectively. Acute toxicities include Grade 1-2 pain (5%), genitourinary (7%), gastrointestinal (12%), soft tissue (5%), and dermatologic (12%). Four patients observed late Grade 3-4 toxicities, including rectal bleeding/fistula and soft tissue necrosis.
  
  
  
  High-dose-rate IBT is an effective treatment for locally recurrent endometrial carcinoma with an acceptable toxicity profile. Outcomes are similar between previously irradiated and nonirradiated patients. In women who have received prior radiotherapy and are often considered for palliative treatment, interstitial brachytherapy is a potentially curative option.
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Kitty
authors.initials: K
authors.lastname: Huang
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada. Electronic address: david.dsouza@lhsc.on.ca.
authors.forename: David
authors.initials: D
authors.lastname: D'Souza
authors.affiliation: Department of Radiation Oncology, Capital District Health Authority, Dalhousie University, Nova Scotia, Canada.
authors.forename: Nikhilesh
authors.initials: N
authors.lastname: Patil
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Vikram
authors.initials: V
authors.lastname: Velker
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Leung
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Frances
authors.initials: F
authors.lastname: Whiston
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Akira
authors.initials: A
authors.lastname: Sugimoto
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Jacob
authors.initials: J
authors.lastname: McGee
authors.affiliation: Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Prefontaine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000473:pathology; D011879:Radiotherapy Dosage; D012003:Rectal Fistula / Q000209:etiology*; D019233:Retreatment; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Endometrial carcinoma; High dose rate; High volume; Interstitial brachytherapy; Salvage