Intravaginal 1-week high-dose-rate brachytherapy alone for Stages I–II endometrial cancer

Martínez-Monge, Rafael; Nagore, Gorka; Cambeiro, Mauricio; Garrán, Cristina; Villafranca, Elena; Jurado, Matías

doi:10.1016/j.brachy.2007.04.001

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Volume 6, Issue 3 , Pages 195-200, July 2007

Intravaginal 1-week high-dose-rate brachytherapy alone for Stages I–II endometrial cancer

Rafael Martínez-Monge
- Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain
- Corresponding author. Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Avda Pío XII s/n, E-31080 Pamplona, Navarra, Spain. Tel.: +34-948-255400; fax: +34-948-255500.
Gorka Nagore
- Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain
Mauricio Cambeiro
- Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain
Cristina Garrán
- Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain
Elena Villafranca
- Department of Oncology, Hospital de Navarra, Pamplona, Navarra, Spain
Matías Jurado
- Department of Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarra, Spain

Received 29 January 2007; received in revised form 11 April 2007; accepted 13 April 2007.

Abstract

Objective

To evaluate the feasibility and intermediate-term results of a short course of high-dose-rate (HDR) intravaginal brachytherapy only after hysterectomy.

Methods and materials

From December 1999 to February 2005, 50 patients with International federation of gynecology and obstetrics Stages IA–IIB endometrioid endometrial adenocarcinoma were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by postoperative HDR brachytherapy alone. The mean age of the patients was 62.6 years (range 42–86). International federation of gynecology and obstetrics patient grouping included IaG3N_x (n=1), IbG1N₀ (n=1), IbG1N_x (n=2), IbG2N₀ (n=10), IbG2N_x (n=20), IbG3N₀ (n=3), IbG3N_x (n=1), IcG1N_x (n=2), IcG2N₀ (n=3), IcG3N₀ (n=3), IIaG1N_x (n=2), IIaG2N_x (n=1), and IIbG1N₀ (n=1). Twenty-one patients (42.0%) had been surgically staged. Four to 16 weeks after surgery (median 42d, range 28–112), all patients received HDR intravaginal brachytherapy to 25Gy in five consecutive 5-Gy daily fractions prescribed at 0.5-cm depth. Median HDR brachytherapy treatment duration was 5 days (range 5–12).

Results

After a median followup of 37 months (range 12–80), the overall survival and disease-free survival were 96%. No vaginal or pelvic recurrences have been observed. One patient (2%) developed distant metastases. No late toxicities of Grade 3 or greater have been reported.

Conclusions

The results reported in this study are in agreement with previous reports of postoperative HDR brachytherapy alone in early-stage endometrial cancer. HDR brachytherapy alone seems to provide adequate tumor control. The fractionation schedule proposed (25Gy in five consecutive daily treatments) was well tolerated and is convenient for patients living far from the radiation center.

Keywords: Endometrial cancer, Intravaginal brachytherapy, High dose rate, Adjuvant, Exclusive