Preliminary clinical outcomes of patients treated with vaginal brachytherapy alone using multi-channel vaginal brachytherapy applicator in operated early-stage endometrial cancer
Abstract
Background: Recommendations for adjuvant treatment for postoperative, early-stage endometrial cancer varies from observation through vaginal brachytherapy alone to pelvic radiation. While observation alone can lead to recurrence, external radiotherapy has increased morbidity. The aim of this study is to show our results with vaginal brachytherapy alone using a multichannel applicator for treatment of early-stage endometrial cancer.
Materials and methods: Consecutive patients undergoing vaginal brachytherapy alone following surgery for early-stage endometrial cancer were examined. A Miami multichannel vaginal brachytherapy applicator was used to deliver HDR brachytherapy in 62 patients from May 2013 to June 2018. CT scan-based images guided planning. A dose of 5.5–6.5 Gy × 4 fractions was prescribed 5 mm from the surface of the applicator.
Results: At a median follow up of 19 months (6–48 months), 93% of patients treated were alive with no recurrence. Two patients had only local recurrence, and 1 was salvaged with external radiotherapy and chemotherapy. There was only one nodal failure and 2 distant failures. There was no grade 2 or higher vaginal, gastrointestinal or genitourinary toxicity.
Conclusion: Vaginal brachytherapy alone using a multichannel applicator can be considered for early-stage endometrial cancers without compromising outcomes.
Keywords: endometriumbrachytherapymultichannel brachytherapy applicator
References
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018; 68(1): 7–30.
- Maheshwari A, Kumar N, Mahantshetty U. Gynecological cancers: A summary of published Indian data. South Asian J Cancer. 2020; 05(03): 112–120.
- Kong A, Johnson N, Kitchener HC, et al. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012; 104(21): 1625–1634.
- Nout RA, van de Poll-Franse LV, Lybeert MLM, et al. PORTEC Study Group. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011; 29(13): 1692–1700.
- Blake P, Swart AM, Orton J, et al. ASTEC/EN.5 Study Group. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009; 373(9658): 137–146.
- Keys HM, Roberts JA, Brunetto VL, et al. Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004; 92(3): 744–751.
- McCloskey SA, Tchabo NE, Malhotra HK, et al. Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation. Gynecol Oncol. 2010; 116(3): 404–407.
- Nout RA, Smit VT, Putter H, et al. PORTEC Study Group. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010; 375(9717): 816–823.
- Kellas-Ślęczka S, Wojcieszek P, Białas B. Educational Corner Adjuvant vaginal brachytherapy as a part of management in early endometrial cancer. J Contemp Brachyther. 2012; 4: 247–252.
- Jolly S, Vargas C, Kumar T, et al. Vaginal brachytherapy alone: an alternative to adjuvant whole pelvis radiation for early stage endometrial cancer. Gynecol Oncol. 2005; 97(3): 887–892.
- Lin LL, Mutch DG, Rader JS, et al. External radiotherapy versus vaginal brachytherapy for patients with intermediate risk endometrial cancer. Gynecol Oncol. 2007; 106(1): 215–220.
- NCCN Clinical Practice Guidelines. Uterine Neoplasms. Version 2.2018, May 2018.
- Creutzberg CL, Nout RA, Lybeert MLM, et al. PORTEC Study Group. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011; 81(4): e631–e638.
- Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009; 27(21): 3547–3556.
- Demanes D, Rege S, Rodriquez R, et al. The use and advantages of a multichannel vaginal cylinder in high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 1999; 44(1): 211–219.
- Bahadur YA, Constantinescu C, Hassouna AH, et al. Single versus multichannel applicator in high-dose-rate vaginal brachytherapy optimized by inverse treatment planning. J Contemp Brachytherapy. 2015; 6(4): 362–370.
- Iftimia I, Cirino ET, Mower HW, et al. Treatment planning methodology for the Miami Multichannel Applicator following the American Brachytherapy Society recently published guidelines: the Lahey Clinic experience. J Appl Clin Med Phys. 2013; 14(1): 4098.
- Small W, Beriwal S, Demanes DJ, et al. American Brachytherapy Society. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012; 11(1): 58–67.
- Gebhardt BJ, Vargo JA, Kim H, et al. Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina. Gynecol Oncol. 2018; 150(2): 293–299.
- Chadha M, Nanavati PJ, Liu P, et al. Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy. Gynecol Oncol. 1999; 75(1): 103–107.
- Anderson J, Stea B, Hallum A, et al. High-dose-rate postoperative vaginal cuff irradiation alone for stage Ib and Ic endometrial cancer. Int J Radiat Oncol Biol Phys. 2000; 46(2): 417–425.
- Rittenberg PVC, Lotocki RJ, Heywood MS, et al. High-risk surgical stage 1 endometrial cancer: outcomes with vault brachytherapy alone. Gynecol Oncol. 2003; 89(2): 288–294.
- Rittenberg PVC, Lotocki RJ, Heywood MS, et al. Stage II endometrial carcinoma: limiting post-operative radiotherapy to the vaginal vault in node-negative tumors. Gynecol Oncol. 2005; 98(3): 434–438.
- Rasool N, Fader A, Seamon L, et al. Stage I, grade 3 endometrioid adenocarcinoma of the endometrium: An analysis of clinical outcomes and patterns of recurrence. Gynecol Oncol. 2010; 116(1): 10–14.
- Desai NB, Kiess AP, Kollmeier MA, et al. Patterns of relapse in stage I-II uterine papillary serous carcinoma treated with adjuvant intravaginal radiation (IVRT) with or without chemotherapy. Gynecol Oncol. 2013; 131(3): 604–608.
- Matsuo K, Machida H, Ragab OM, et al. Extent of pelvic lymphadenectomy and use of adjuvant vaginal brachytherapy for early-stage endometrial cancer. Gynecol Oncol. 2017; 144(3): 515–523.