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Image-guided brachytherapy following external-beam radiation therapy for patients with inoperable endometrial cancer

  • Chi-Hsien Huang
    Affiliations
    Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
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  • Ji-An Liang
    Affiliations
    Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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  • Yao-Ching Hung
    Affiliations
    Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
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  • Lian-Shung Yeh
    Affiliations
    Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
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  • Wei-Chun Chang
    Affiliations
    Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
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  • Wu-Chou Lin
    Affiliations
    Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan

    College of Chinese Medicine, China Medical University, Taichung, Taiwan
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  • Yin-Yi Chang
    Affiliations
    Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan

    College of Chinese Medicine, China Medical University, Taichung, Taiwan
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  • Shang-Wen Chen
    Correspondence
    Corresponding author. Department of Radiation Oncology, China Medical University Hospital, No. 2, Yude Rd., North Dist., Taichung City, Taiwan.
    Affiliations
    Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Radiology, College of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
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Published:October 13, 2022DOI:https://doi.org/10.1016/j.brachy.2022.09.004

      Abstract

      Objective

      To investigate the outcomes of definitive external-beam radiation therapy (EBRT) plus image-guided brachytherapy (IGBT) in patients with endometrial cancer (EC) unsuitable for surgery.

      Methods

      A total of 50 patients with inoperable EC were included. The patients received EBRT in a median dose of 45 Gy to the pelvis over 5 weeks. Thereafter, the patients received brachytherapy using tandem and ovoid applicators. High-risk clinical target volume (HR-CTV) and gross tumor volume in brachytherapy (GTVp) were defined by the assistance of patients’ pre-IGBT magnetic resonance imaging.

      Results

      The medical records of the 50 patients were analyzed. The main causes of inoperability were anesthesia contraindications, namely medical comorbidities and obesity. The median cumulative D90s (the minimum dose delivered to 90% of the volume) in EQD2 (equivalent dose in 2-Gy fractions) to the HR-CTV and GTVp were 72.9 Gy10 (range, 64.9 to 80.3) and 166.2 Gy10 (range, 123.0 to 189.8), respectively. Over a median follow-up period of 27 months, 8 of the patients died of cancer. The 2-year overall and cancer-specific survival rates were 75% and 83%, respectively. The cumulative incidences of pelvic and distant failure were 4% (n = 2) and 16% (n = 8), respectively. Gastrointestinal complications of grade 2 or above were noted in 2 patients (4%), and a grade 2 genitourinary complication was noted in one.

      Conclusions

      For patients with inoperable EC, EBRT followed by IGBT is an effective approach for achieving high local control without a high risk of complications.

      Keywords

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