Abstract
PURPOSE
The aim of this investigation is to characterize vaginal apex “dog ears” and their
association with patterns of treatment failure in patients with endometrial cancer
treated with adjuvant high-dose-rate (HDR) single-channel vaginal cuff brachytherapy
(VCB).
METHODS
A retrospective review of patients treated with HDR VCB from 2012 to 2021 for medically
operable endometrial cancer at a single institution was conducted. Dog ears, defined
as tissue at the apex extending at least 10 mm from the brachytherapy applicator were
identified on CT simulation images. Fisher exact test and a multivariate logistic
regression model evaluated the association between factors of interest with treatment
failure. Vaginal cuff failure free survival (VCFFS) was calculated from first brachytherapy
to vaginal cuff recurrence (VCR).
RESULTS
A total of 219 patients were reviewed. In this sample, 57.5% of patients met criteria
for having dog ears. In total, 13 patients (5.9%) developed a VCR. There was no statistically
significant difference in the rate of VCR between patients with and without dog ears
(7.1% vs. 4.3%, p = 0.56). There was a trend toward increased risk of recurrence with higher grade histology
identified in the multivariate logistic regression model (p = 0.085). The estimated 3-year probability of VCFFS was 86%.
CONCLUSIONS
Vaginal apex dog ears are prevalent but are not found to statistically increase the
risk of VCR after VCB in our single institution experience. However, while local failure
remains low in this population, we report an absolute value of over twice as many
VCRs in patients with dog ears, indicating that with improved dog ear characterization
this may remain a relevant parameter for consideration in treatment planning.
Keywords
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Article info
Publication history
Published online: November 19, 2022
Accepted:
October 21,
2022
Received in revised form:
October 19,
2022
Received:
July 22,
2022
Publication stage
In Press Corrected ProofFootnotes
Disclosures: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Research data: Patient level data not allowed to be shared per IRB.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
Published by Elsevier Inc. on behalf of American Brachytherapy Society.
