Salvage high-dose-rate brachytherapy for isolated vaginal recurrence of endometrial cancer.
We have retrospectively analyzed the outcomes of high-dose-rate (HDR) brachytherapy as a salvage therapy for vaginal recurrence of endometrial cancer.



From 1997 to 2012, salvage HDR brachytherapy was performed in 43 patients. The median age was 64 years (range, 41-88 years). HDR brachytherapy was performed by interstitial brachytherapy in 34 patients (79%) and by intracavity brachytherapy in nine patients (21%). Seventeen (40%) of the 43 patients were treated with external beam radiotherapy. The median followup period was 58 months (range, 6-179 months).



The 5-year overall survival (OS), progression-free survival (PFS), and local control rates (LC) were 84%, 52%, and 78%, respectively. Patients who received brachytherapy with external beam radiotherapy experienced no nodal recurrence (0 of 17 patients), whereas 23% of the patients (6 of 26 patients) who received brachytherapy alone experienced nodal recurrence (p = 0.047). The pathologic grade at the time of initial surgery (G1-2 vs. G3) was found to be a significant prognostic factor for both OS and PFS. The respective 5-year OS was 96% vs. 40% (p < 0.01), and the 5-year PFS was 58% vs. 0% (p < 0.01). Age (≥60 vs. <60) and modality (interstitial brachytherapy vs. intracavity brachytherapy) were significant prognostic factors for LC. The respective 5-year LC was 74% vs. 100% (p = 0.020) and 85% vs. 56% (p = 0.035).



HDR brachytherapy is effective and feasible in patients with isolated vaginal recurrence of endometrial cancer. Pathologic grade, age, and modality were significant prognostic factors.
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. Electronic address: haku@radonc.med.osaka-u.ac.jp.
Sungjae
S
Baek
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Fumiaki
F
Isohashi
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Hiroko
H
Yamaguchi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Seiji
S
Mabuchi
Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
Ken
K
Yoshida
Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan.
Tadayuki
T
Kotsuma
Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan.
Hideya
H
Yamazaki
Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan.
Eiichi
E
Tanaka
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Iori
I
Sumida
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Keisuke
K
Tamari
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Keisuke
K
Otani
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Yuji
Y
Seo
Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Osamu
O
Suzuki
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Yasuo
Y
Yoshioka
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Tadashi
T
Kimura
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Kazuhiko
K
Ogawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000473:pathology / Q000532:radiotherapy*
Brachytherapy; Endometrial cancer; High dose rate; Vaginal recurrence