Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients

Abstract

Purpose

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.

Materials and 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.

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