Clinical outcomes following 3D image-guided brachytherapy for vaginal recurrence of endometrial cancer

ArticleinGynecologic Oncology 131(3) · September 2013with9 Reads
Impact Factor: 3.77 · DOI: 10.1016/j.ygyno.2013.08.040 · Source: PubMed

    Abstract

    To evaluate clinical outcomes for women with recurrent endometrial cancer treated with 3D image-guided brachytherapy Methods and Materials 44 women received salvage RT for vaginal recurrence from 9/03-8/11. HDR or LDR interstitial brachytherapy was performed under MR or CT guidance in 35 patients (80%); 9 (20%) had CT-guided HDR cylinder brachytherapy. The median cumulative dose in EQD2 was 75.5Gy. Actuarial estimates of local failure (LF), DFS and OS were calculated by Kaplan-Meier.
    Histologic subtypes were endometrioid (EAC, 33), papillary serous/clear cell (UPSC/CC, 5) and carcinosarcoma (CS, 6). The 2-year DFS/OS rates were 59%/72% overall, 75%/89% for EAC, and 11%/24% for UPSC/CC/CS (both p<0.01). On MVA, high tumor grade was associated with recurrence (HR 3.2 for grade 2, 9.6 for grade 3, p<0.01). The cumulative incidence of LF at 2years was 12%; median cumulative dose for patients with LF was 66.2Gy and 73.9Gy for those without LF (p=0.02). When excluding 13 patients who had prior RT, the 2-year LF rate was 4%. Patients who had prior RT received lower cumulative doses at recurrence (66.5Gy vs. 74.4Gy, p<0.01). Four patients (9%) experienced grade 3 late toxicity, including 3 of 13 (23%) in the re-irradiation setting and 1 if 31 (3%) with no prior radiotherapy.
    3D image-guided brachytherapy results in excellent local control for women with recurrent endometrial cancer, particularly with cumulative EQD2 doses greater than 70Gy. Successful salvage of vaginal recurrence is strongly related to tumor grade and histologic subtype.