Abstract
PURPOSE
To evaluate the role and technique of a vaginal cuff brachytherapy (VB) boost to adjuvant
external beam (EB) radiation for endometrial cancer through a systematic review.
METHODS AND MATERIALS
Relevant trials were identified through a systematic search of the literature.
RESULTS
A total of 21 prospective and retrospective studies which had a patient cohort undergoing
EB + VB was identified to evaluate for rates of vaginal and pelvic recurrences, overall
survival, and toxicity. Additional database studies were utilized to demonstrate differences
in local control and overall survival between EB and EB + VB.
CONCLUSIONS
While there is limited prospective evidence to guide the use of a VB boost after EB,
the evidence suggests that patients with a higher risk of a vaginal recurrence such
as those with cervical stromal involvement in select Stage III patients may derive
local control and survival benefits from a VB boost. Additional individual risk factors
such as grade, histology, extent of invasion, margin status, age, and the use of lower
doses of EB should be considered when deciding when to add a VB boost.
Keywords
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References
- SEER Cancer Statistics Review, 1975-2018.National Cancer Institute, Bethesda, MD2020 (Available at:) (SEER data submission, posted to the SEER web site, April 2021)
- Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study.Int J Gynecol Cancer. 2009; 19 (Jul PMID: 19574776): 873-878https://doi.org/10.1111/IGC.0b013e3181a6c9df
- Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma.Int J Radiat Oncol Biol Phys. 2011; 81 (Nov 15 Epub 2011 Jun 2. PMID:21640520): e631-e638https://doi.org/10.1016/j.ijrobp.2011.04.013
- 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 (Mar Erratum in: Gynecol Oncol. 2004 Jul;94(1):241-2. PMID:14984936): 744-751https://doi.org/10.1016/j.ygyno.2003.11.048
- Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy.Br J Cancer. 2018; 119 (Oct Epub 2018 Oct 25. PMID:30356126PMCID: PMC6219495): 1067-1074https://doi.org/10.1038/s41416-018-0310-8
National Comprehensive Cancer Network. Uterine Neoplasms (Version 2.2021) Available at: https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed May 18.
- American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review.Brachytherapy. 2017; 16 (Jan-Feb Epub 2016 May 31. PMID:27260082PMCID: PMC5612425): 95-108https://doi.org/10.1016/j.brachy.2016.04.005
- Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients.Obstet Gynecol. 1980; 56 (Oct PMID:6999399): 419-427
- Endometrial carcinoma: high dose-rate brachytherapy in combination with external irradiation; a multivariate analysis of relapses.Radiother Oncol. 1989; 16 (Dec PMID:2616811): 245-252https://doi.org/10.1016/0167-8140(89)90036-4
- Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma.Int J Radiat Oncology*BiolPhys. 1990; 19 (ISSN 0360-3016): 49-54
- Postoperative high dose-rate intravaginal brachytherapy combined with external irradiation for early stage endometrial cancer: a long-term follow-up.Int J Radiat Oncol Biol Phys. 1994; 30: 831-837
- Improved outcome in patients treated with postoperative radiation therapy for pathologic stage III endometrial cancer.Int J Radiat OncolBiolPhys. 1996; 35: 925-933
- The role of adjuvant radiotherapy in carcinoma of the endometrium—results in 550 patients with pathologic stage i disease.Gynecol Oncol. 1998; 70: 247-254
- Is there a role for a brachytherapy vaginal cuff boost in the adjuvant management of patients with uterine-confined endometrial cancer?.Int J Radiat Oncol Biol Phys. 1998; 42: 101-104
- Adjuvant high-dose rate brachytherapy with or without external beam radiotherapy post-hysterectomy for endometrial cancer.Int J Gynecol Cancer. 1999; 9: 247-255
- Predictors of recurrence in surgical stage II endometrial adenocarcinoma.Gynecol Oncol. 1999; 73 (Jun PMID:10366468): 407-411https://doi.org/10.1006/gyno.1999.5380
- Survival of women with surgical stage II endometrial cancer.Gynecol Oncol. 1999; 74: 80-85
- Stage II endometrial carcinoma: prognostic factors and risk classification in 170 patients.Int J Radiat Oncol Biol Phys. 2002; 53 (Jul 15 PMID:12095551): 862-867https://doi.org/10.1016/s0360-3016(02)02813-4
- A pilot trial of TAC (paclitaxel, doxorubicin, and carboplatin) chemotherapy with filgastrim (r-metHuG-CSF) support followed by radiotherapy in patients with "high-risk" endometrial cancer.Gynecol Oncol. 2005; 96 (Jan PMID:15589601): 198-203https://doi.org/10.1016/j.ygyno.2004.09.022
- Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer.Gynecol Oncol. 2006; 103 (Oct Epub 2006 Mar 20. PMID:16545437): 155-159https://doi.org/10.1016/j.ygyno.2006.02.007
- Stage II adenocarcinoma of the endometrium: adjuvant radiotherapy and recurrence patterns.Int J Radiat OncolBiol*Phys. 2008; 71: 205-212
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. The Lancet2009;373:137–146.
- Outcomes following surgery and adjuvant radiation in stage II endometrial adenocarcinoma.Gynecol Oncol. 2009; 113 (May Epub 2009 Feb 12. PMID:19217147): 176-180https://doi.org/10.1016/j.ygyno.2008.12.029
- Adjuvant carboplatin and paclitaxel chemotherapy interposed with involved field radiation for advanced endometrial cancer.Gynecol Oncol. 2009; 114 (Jul Epub 2009 Apr 29. PMID:19406459): 94-98https://doi.org/10.1016/j.ygyno.2009.03.027
- Survival analysis of endometrial cancer patients with cervical stromal involvement.J Gynecol Oncol. 2014; 25 (Apr Epub 2014 Apr 9. PMID:24761213PMCID: PMC3996259): 105-110https://doi.org/10.3802/jgo.2014.25.2.105
- Adjuvant radiotherapy in Stage II endometrial carcinoma: Is brachytherapy alone sufficient for local control?.Brachytherapy. 2015; 14 (Jul-Aug Epub 2015 Apr 22. PMID:25911995): 427-432https://doi.org/10.1016/j.brachy.2015.02.196
- The impact of a vaginal brachytherapy boost to pelvic radiation in stage III endometrial cancer.J Contemp Brachytherapy. 2015; 7 (Apr Epub 2015 Apr 20. PMID:26034492PMCID: PMC4444456): 122-127https://doi.org/10.5114/jcb.2015.50877
- The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline.Pract Radiat Oncol. 2014; 4 (May-Jun Epub 2014 Mar 31. PMID:24766678): 137-144https://doi.org/10.1016/j.prro.2014.01.003
- External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma–a prospective randomized study.Int J Radiat Oncol Biol Phys. 2012; 82 (Mar 1 Epub 2011 Jun 14. PMID:21676554): 1249-1255https://doi.org/10.1016/j.ijrobp.2011.04.014
- Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial.J Clin Oncol. 2004; 22 (Apr 1 PMID:15051771): 1234-1241https://doi.org/10.1200/JCO.2004.08.159
- Does brachytherapy improve survival in addition to external beam radiation therapy in patients with high risk stage I and II endometrial carcinoma?.Am J Clin Oncol. 2010; 33 (Aug PMID:20689365): 364-369https://doi.org/10.1097/COC.0b013e3181b0c266
- Cervical stromal invasion predicting survival in endometrial cancer.Obstet Gynecol. 2010; 116 (Nov PMID:20966686): 1035-1041https://doi.org/10.1097/AOG.0b013e3181f73fc2
- Poppe MM. Brachytherapy Improves Survival in Stage III Endometrial Cancer With Cervical Involvement.Int J Radiat Oncol Biol Phys. 2017; 97 (Apr 1 Epub 2017 Jan 4. PMID:28332987): 1040-1050https://doi.org/10.1016/j.ijrobp.2016.12.035
- Adjuvant brachytherapy removes survival disadvantage of local disease extension in stage IIIC endometrial cancer: a SEER registry analysis.Int J Radiat Oncol Biol Phys. 2008; 70 (Jan 1 Epub 2007 Sep 12. PMID:17855014): 134-138https://doi.org/10.1016/j.ijrobp.2007.05.048
- Adjuvant vaginal brachytherapy decreases the risk of vaginal recurrence in patients with stage I non-invasive uterine papillary serous carcinoma. A multi-institutional study.Gynecol Oncol. 2015; 136 (Mar Epub 2015 Jan 7. PMID:25575483): 529-533https://doi.org/10.1016/j.ygyno.2014.12.034
- Integrated genomic characterization of endometrial carcinoma.Nature. 2013; 497: 67-73
- Mismatch repair deficiency as a predictive marker for response to adjuvant radiotherapy in endometrial cancer.Gynecol Oncol. 2019; 154: 124-130
- Molecular classification of the PORTEC-3 trial for high-risk endometrial cancer: impact on prognosis and benefit from adjuvant therapy.J Clin Oncol. 2020; 38: 3388
- Pros and cons of vaginal brachytherapy after external beam radiation therapy in endometrial cancer.Gynecol Oncol. 2016; 140: 167-175
Zhang Y., Rovirosa A., Ascaso C., Herreros A., Torne A., Li Y., Biete A., Sánchez J. Economic impact of decreasing the fraction number in vaginal cuff brachytherapy: A direct cost analysis. Brachytherapy. 2020 Jan-Feb;19(1):60-65. doi: 10.1016/j.brachy.2019.09.004. Epub 2019 Oct 3. PMID: 31587986.
- Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG Oncology–RTOG 1203.J Clin Oncol. 2018; 36: 2538-2544
- NRG Oncology/RTOG 0921: A phase 2 study of postoperative intensity-modulated radiotherapy with concurrent cisplatin and bevacizumab followed by carboplatin and paclitaxel for patients with endometrial cancer.Cancer. 2015; 121 (Jul 1 Epub 2015 Apr 6. PMID:25847373PMCID: PMC4685031): 2156-2163https://doi.org/10.1002/cncr.29337
- Time-driven activity-based costing of adjuvant vaginal cuff brachytherapy for uterine cancer in an integrated brachytherapy suite.Brachytherapy. 2020; 19 (Mar-Apr Epub 2019 Dec 24. PMID:31870729): 176-180https://doi.org/10.1016/j.brachy.2019.11.007
- A population-based study of subsequent primary malignancies after endometrial cancer: genetic, environmental, and treatment-related associations.Int J Radiat Oncol Biol Phys. 2010; 78 (Sep 1 Epub 2009 Nov 10. PMID:19910129): 127-135https://doi.org/10.1016/j.ijrobp.2009.07.1692
- Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk.J Natl Cancer Inst. 2007; 99: 1634-1643
- Radiation dose and second cancer risk in patients treated for cancer of the cervix.Radiat Res. 1988; 116: 3-55
- Second primary cancer after treatment for cervical cancer. an international can-cer registries study.Cancer. 1995; 76: 442-452
- American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy.Brachytherapy. 2012; 11 (Jan-Feb PMID:22265439): 58-67https://doi.org/10.1016/j.brachy.2011.08.005
- Vaginal cuff brachytherapy in endometrial cancer - a technically easy treatment?.Cancer Manag Res. 2017; 9 (Aug 9 PMID:28848362PMCID: PMC5557121): 351-362https://doi.org/10.2147/CMAR.S119125
- Compendium of fractionation choices for gynecologic HDR brachytherapy-An American Brachytherapy Society Task Group Report.Brachytherapy. 2019; 18 (Jul-Aug Epub 2019 Apr 9. PMID:30979631): 429-436https://doi.org/10.1016/j.brachy.2019.02.008
- EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma.Cancers (Basel). 2020; 12 (Oct 20 PMID:33092163PMCID: PMC7589275): 3059https://doi.org/10.3390/cancers12103059
- Is one brachytherapy fraction of 7 Gy similar to more fractions after external beam irradiation in postoperative endometrial carcinoma?.Clin Transl Oncol. 2020; 22 (Aug Epub 2019 Dec 21. PMID:31865604): 1295-1302https://doi.org/10.1007/s12094-019-02255-z
- Do vaginal recurrence rates differ among adjuvant vaginal brachytherapy regimens in early-stage endometrial cancer?.Brachytherapy. 2019; 18 (Jul-Aug Epub 2019 Apr 17. PMID:31005603): 453-461https://doi.org/10.1016/j.brachy.2019.03.001
- Comparison of high-dose-rate and low-dose-rate brachytherapy in the treatment of endometrial carcinoma.Inte JRadiat OncolBiolPhys. 2007; 67 (ISSN 0360-3016): 480-484
- Associations between lymphovascular space invasion, nodal recurrence, and survival in patients with surgical stage I endometrioid endometrial adenocarcinoma.World J Surg Oncol. 2019; 17 (May 10 PMID:31077193PMCID: PMC6511118): 80https://doi.org/10.1186/s12957-019-1620-x
- Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy.Abdom Radiol (NY). 2020; 45 (Apr PMID:32112139PMCID: PMC7643338): 1122-1131https://doi.org/10.1007/s00261-020-02453-2
- Lymphovascular space invasion (LVSI) is an isolated poor prognostic factor for recurrence and survival among women with intermediate- to high-risk early-stage endometrioid endometrial cancer.Int J Gynecol Cancer. 2013; 23: 1438
Article info
Publication history
Accepted:
October 19,
2021
Received in revised form:
October 10,
2021
Received:
June 17,
2021
Footnotes
Disclosures: All authors declare that they have no conflict of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of American Brachytherapy Society.
