Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T07:26:40.109Z Has data issue: false hasContentIssue false
  • English
  • Français

Are outcomes of adjuvant vaginal vault brachytherapy in endometrial cancer related to the way it is delivered?

Published online by Cambridge University Press:  12 December 2011

M. Alzouebi ,
S.D. Pledge  and
J.E. Martin
M. Alzouebi*
Affiliation:
Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
S.D. Pledge
Affiliation:
Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
J.E. Martin
Affiliation:
Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
*
Correspondence to: M. Alzouebi, MRCP, MBChb, MSc, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. E-mail: mymoona.alzouebi@sth.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims: Endometrial cancer is the commonest malignancy of the female genital tract. Surgery forms the cornerstone of treatment with adjuvant therapy proven to reduce local recurrence without demonstrating a clear survival benefit. The selection of adjuvant therapy is becoming increasingly more complex. The aim of this study was to investigate current adjuvant practices by reviewing outcomes of patients with endometrial cancer treated with intracavitary vaginal brachytherapy (VB).

Materials & Methods: A retrospective analysis was carried out of all women with Stage II endometrial endometroid adenocarcinoma treated at Weston Park Hospital, Sheffield with adjuvant VB from 2003–2006. The data collected and analysed included histology, stage and grade of disease, radiotherapy treatment–related parameters, morbidity, recurrence rates and survival rates. Kaplan-Meier was used to analyse recurrence-free and overall survival rates. Wilson’s score was used to determine statistical significance of outcomes. Attention was focused on the method of treatment delivery, and this was compared with available literature.

Results: In total, 33 patients were identified. All patients were treated with LDR 48 Gy prescribed to the surface of the applicator. Median follow-up was 36 months. Vaginal, pelvic and distant relapse rates were 9%, 15% and 18%, respectively. Recurrence-free and overall survival rates were 78.8% and 84.8%, respectively. Six of the seven patients (86%) who recurred developed distant metastases, not influenced by VB. No severe (Grade 3 or 4 toxicity) was recorded. When vaginal relapse rates were compared to published trials based on technique used, no statistically significant difference was demonstrated.

Conclusion: Rates of vaginal relapses were comparable to the available literature suggesting current VB practice is an effective adjuvant local treatment. The study highlights the importance of surveillance and patient education regarding toxicity and its prevention with particular attention drawn to vaginal stenosis.

Keywords

endometrial cancervaginal brachytherapypelvic external beam radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 11 , Issue 3 , September 2012 , pp. 170 - 183
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

UK Cancer Incidence Statistics. Cancer Research UK. Accessed 4 July 2010. http://info.cancerresearchuk.org/cancerstats/types/uterus/incidence/uk-uterus-cancer-incidence-statisticsGoogle Scholar
Pecorelli, S, Benedet, JL, Creasman, WT, Shepherd, JH. FIGO staging of gynecologic cancer. 1994–1997 FIGO Committee on Gynecologic Oncology. International Federation of Gynecology and Obstetrics. Int J Gynaecol Obstet 1999; 64:5–10.CrossRefGoogle ScholarPubMed
Aalders, JG, Abeler, V, Kolstad, P. Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients. Gynecol Oncol 1984; 17:85–103.CrossRefGoogle ScholarPubMed
Creutzberg, CL, van Putten, WL, Koper, PC et al. . Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 2000; 355:1404–1411.CrossRefGoogle Scholar
Keys, HM, Roberts, JA, Brunetto, VL et al. ; 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; 92:744–751.CrossRefGoogle ScholarPubMed
Koh, W-J. Early stage endometrial cancer: To radiate or not to radiate – that is the question. Gynecol Oncol 2008; 110:271–274.CrossRefGoogle ScholarPubMed
Baekelandt, MM, Castiglione, M; ESMO Guidelines Working Group. Endometrial carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2008; 19 Suppl 2:ii19–ii20.CrossRefGoogle Scholar
Petric, P, Potter, R. European Society for Therapeutic Radiology and Oncology (ESTRO). Endometrium cancer: post-operative brachytherapy techniques. Survey presented in Amsterdam October 2009. Medical University of Vienna, Department of Radiotherapy and Radiobiology.Google Scholar
Nout, R, Putter, H, Jürgenliemk-Schulz, I et al. . Vaginal brachytherapy versus external beam pelvic radiotherapy for high-intermediate risk endometrial cancer: results of the randomised PORTEC-2 trial. Journal Clin Oncol 2008; 26(suppl LBA5503): 1010s.CrossRefGoogle Scholar
Obermair, A, Cheuk, R, Pak, SC et al. . Disease-free survival after vaginal vault brachytherapy versus observation for patients with node-negative intermediate-risk endometrial adenocarcinoma. Gynecol Oncol 2008; 110:280–285.CrossRefGoogle ScholarPubMed
Jolly, S, Vargas, C, Kumar, T et al. . Vaginal brachytherapy alone: an alternative to adjuvant whole pelvis radiation for early stage endometrial cancer. Gynecol Oncol 2005; 97:887–892.CrossRefGoogle ScholarPubMed
Creutzberg, CL, van Putten, WL, Koper, PC et al. ; PORTEC Study Group. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 2003; 89:201–209.CrossRefGoogle ScholarPubMed
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–383.CrossRefGoogle ScholarPubMed
Trotti, A, Byhardt, R, Stetz, J et al. . Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys 2000; 47:13–47.CrossRefGoogle ScholarPubMed
Dose and Volume Specification for Reporting Intracavitary Therapy in Gynecology (ICRU Report 38). Accessed 7 March 2011. http://www.icru.org/index.php?option=com_content&task=view&id=86Google Scholar
Statistical Package for the Social Sciences SPSS. SPSS for Windows. Released 2003–2004. Chicago. Accessed 7 March 2011. http://www.spss.com/software/statistics/Google Scholar
Newcombe, RG. Statistical applications in orthodontics: part II. Confidence intervals for proportions and their differences. J Orthod 2000; 27:339–340.CrossRefGoogle ScholarPubMed
Emami, B, Lyman, J, Brown, A et al. . Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21:109–122.CrossRefGoogle ScholarPubMed
Elliott, P, Green, D, Coates, A et al. . The efficacy of postoperative vaginal irradiation in preventing vaginal recurrence in endometrial cancer. Int J Gynecol Cancer 1994; 4:84–93.CrossRefGoogle ScholarPubMed
Steiner, E, Eicher, O, Sagemüller, J et al. . Multivariate independent prognostic factors in endometrial carcinoma: a clinicopathologic study in 181 patients: 10 years experience at the Department of Obstetrics and Gynecology of the Mainz University. Int J Gynecol Cancer 2003; 13:197–203.Google ScholarPubMed
Lin, LL, Mutch, DG, Rader, JS, Powell, MA, Grigsby, PW. External radiotherapy versus vaginal brachytherapy for patients with intermediate risk endometrial cancer. Gynecol Oncol 2007; 106:215–220.CrossRefGoogle ScholarPubMed
Alektiar, KM, Venkatraman, E, Chi, DS, Barakat, RR. Intravaginal brachytherapy alone for intermediate-risk endometrial cancer. Int J Radiat Oncol Biol Phys 2005; 62:111–117.CrossRefGoogle ScholarPubMed
Ng, TY, Perrin, LC, Nicklin, JL, Cheuk, R, Crandon, AJ. Local recurrence in high-risk node-negative stage I endometrial carcinoma treated with postoperative vaginal vault brachytherapy. Gynecol Oncol 2000; 79:490–494.CrossRefGoogle Scholar
Cengiz, M, Singh, AK, Grigsby, PW. Postoperative vaginal brachytherapy alone is the treatment of choice for grade 1–2, stage IC endometrial cancer. Int J Gynecol Cancer 2005; 15:926–931.CrossRefGoogle ScholarPubMed
McCloskey, SA, Tchabo, NE, Malhotra, HK et al. . Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation. Gynecol Oncol 2010; 116:404–407.CrossRefGoogle ScholarPubMed
Chadha, M, Nanavati, PJ, Liu, P, Fanning, J, Jacobs, A. Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy. Gynecol Oncol 1999; 75:103–107.CrossRefGoogle ScholarPubMed
Solhjem, MC, Petersen, IA, Haddock, MG. Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer. Int J Radiat Oncol Biol Phys 2005; 62:1379–1384.CrossRefGoogle ScholarPubMed
Petereit, DG, Tannehill, SP, Grosen, EA, Hartenbach, EM, Schink, JC. Outpatient vaginal cuff brachytherapy for endometrial cancer. Int J Gynecol Cancer 1999; 9:456–462.CrossRefGoogle ScholarPubMed
Horowitz, N, Peters, W, Smith, M et al. . Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma. Obstet Gynecol 2002; 99:235–240.Google Scholar
MacLeod, C, Fowler, A, Duval, P et al. . High-dose-rate brachytherapy alone post-hysterectomy for endometrial cancer. Int J Radiat Oncol Biol Phys 1998; 42:1033–1039.CrossRefGoogle ScholarPubMed
Petereit, DG, Frederickson, H, Regarding, Ng et al. : Defining the role of adjuvant radiotherapy for high-risk stage I endometrial patients. Gynecol Oncol 2001; 82:407–409.CrossRefGoogle Scholar
Anderson, JM, Stea, B, Hallum, AV, Rogoff, E, Childers, J. High-dose-rate postoperative vaginal cuff irradiation alone for stage IB and IC endometrial cancer. Int J Radiat Oncol Biol Phys 2000; 46:417–425.CrossRefGoogle ScholarPubMed
Creutzberg, CL. Adjuvant chemotherapy for endometrial cancer: unproven. Int J Gynecol Cancer 2010; 20:S60–S63.CrossRefGoogle ScholarPubMed
Hogberg, T, Rosenberg, P, Kristensen, G et al. . A randomized phase-III study on adjuvant treatment with radiation (RT) ± chemotherapy (CT) in early-stage high-risk endometrial cancer (NSGO-EC-9501/EORTC 5599). J Clin Oncol 2007; 25(18S):5503CrossRefGoogle Scholar
PORTEC-3. Post-operative radiotherapy in endometrial cancer. UK Clinical Research Network. Accessed 18 March 2011. http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=4260Google Scholar
Libby, B, Sen, N, Schneider, B. Retrospective analysis of toxicity from vaginal cuff brachytherapy. Brachytherapy 2010; 9:S23–S102.CrossRefGoogle Scholar
Chong, I, Hoskin, PJ. Vaginal vault brachytherapy as sole postoperative treatment for low-risk endometrial cancer. Brachytherapy 2008; 7:195–199.CrossRefGoogle ScholarPubMed
White, ID, Faithfull, S. Vaginal dilation associated with pelvic radiotherapy: a UK survey of current practice. Int J Gynecol Cancer 2006; 16:1140–1146.CrossRefGoogle ScholarPubMed
Owen Mumford Ltd. National Forum of Gynaecological Oncology Nurses. Best Practice guidelines on the use of vaginal dilators in women receiving pelvic radiotherapy. 2005.Google Scholar
Lancaster, L. Preventing vaginal stenosis after brachytherapy for gynaecological cancer: an overview of Australian practices. Eur J Oncol Nurs 2004; 8:30–39.CrossRefGoogle ScholarPubMed
FIGO (International Federation of Gynecology and Obstetrics) annual report on the results of treatment in gynecological cancer. Int J Gynecol Obstet 2003; 83:1–2.Google Scholar