Intravaginal high-dose-rate brachytherapy for Stage IB (FIGO Grade 1, 2) endometrial cancer Journal Article
| Authors: | Alektiar, K. M.; Mckee, A.; Venkatraman, E.; McKee, B.; Zelefsky, M. J.; Mychalczak, B. R.; Hoskins, W. J.; Barakat, R. R. |
| Article Title: | Intravaginal high-dose-rate brachytherapy for Stage IB (FIGO Grade 1, 2) endometrial cancer |
| Abstract: | Purpose: To evaluate the outcome of patients with Stage IB Grades 1 and 2 endometrial cancer treated with adjuvant high-dose-rate intravaginal brachytherapy. Methods and Materials: Between November 1987 and October 1999, 233 patients with Stage IB FIGO Grades 1 and 2 were treated with postoperative adjuvant high-dose-rate intravaginal brachytherapy. The median dose was 21 Gy in 7 Gy/fraction given at 2-week intervals. The mean age was 60 years. All patients underwent simple hysterectomy. Comprehensive surgical staging, defined as pelvic washing and pelvic and paraaortic lymph nodes sampling, was done in 9% of patients. Patients with FIGO Grade 3, papillary serous cancer, or clear-cell cancer were excluded from this analysis. Complications were assessed in terms of late Radiation Therapy Oncology Group toxicity (Grade ≥3) of the gastrointestinal tract, genitourinary tract, and vagina. Results: With a median follow-up of 57 months, the 5-year vaginal/pelvic control, disease-free survival, and overall survival rate was 96% (95% confidence interval [CI] 94-99%), 94% (95% CI 91-98%), and 94% (95% CI 91-98%), respectively. The influence on outcome of age, grade (1 vs. 2), depth of invasion (one-third or less or greater than one-third), capillary space-like invasion, lower uterine segment involvement, and comprehensive surgical staging was evaluated. None of these factors significantly affected the rate of vaginal/pelvic control. Only age ≥60 years influenced the outcome for disease-free and overall survival. The 5-year rate for both disease-free and overall survival was 90% (95% CI 84-97%) for patients ≥60 years old compared with 99% (95% CI 96-100%) for those <60 years (p = 0.03 and 0.005, respectively). Of 233 patients, 3 (1%) developed Grade 3 or greater complications, with a 5-year actuarial rate of 2% (95% CI 0-5%). Two patients developed Grade 3 genitourinary toxicity, and 1 Grade 4 vaginal toxicity. Conclusion: On the basis of this retrospective study, adjuvant postoperative high-dose-rate intravaginal brachytherapy provides excellent outcomes and acceptable morbidity. These results compare very favorably with those reported in the literature using surgery alone or with pelvic radiation. © 2002 Elsevier Science Inc. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival rate; retrospective studies; major clinical study; cancer recurrence; cancer radiotherapy; radiation dose; radiotherapy, adjuvant; cancer staging; follow up; follow-up studies; endometrial cancer; hysterectomy; endometrial neoplasms; neoplasm staging; endometrium cancer; radiotherapy; morbidity; recurrence; oncology; necrosis; hematuria; tumors; radiation injuries; brachytherapy; toxicity; carcinoma, endometrioid; diseases; cells; urethra stricture; stage ib; hdr brachytherapy; humans; human; female; priority journal; article; pelvic radiations |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 53 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2002-07-01 |
| Start Page: | 707 |
| End Page: | 713 |
| Language: | English |
| DOI: | 10.1016/s0360-3016(02)02792-x |
| PUBMED: | 12062616 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 14 November 2014 -- Source: Scopus |
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