PubMed | Lankenau Hospital Lankenau Institute for Medical Research
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016
e15593 Background: To report a community experience for women diagnosed with intermediate risk (Stage I and II) endometrial carcinoma treated with surgery followed by vaginal cylinder brachytherapy.From January 2003 to February 2011, 51 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB, IC and IIA endometrial carcinoma were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection followed by adjuvant high-dose rate (HDR) vaginal brachytherapy alone. The average age of the patients was 71 years. All patients were completely surgically staged and the average number of lymph nodes removed was 11. Brachytherapy was given 4-8 weeks postoperatively. All patients received 30 Gy in six 5-Gy fractions administered two fractions per week for three weeks. The prescription depth was 0.5 cm for an apical length of 4 cm.After a median follow-up of 34 months (range: 1 to 96), 94% of patients were alive and 98% were free of vaginal cuff recurrence based on Kaplan-Meier analysis. One vaginal cuff recurrence (1.9%), two pelvic recurrences (3.8%) and two distant metastases (3.8%) were observed. 7 of 51 patients (14%) experienced grade one toxicities which included 4 with vaginal telangiectasias and mild friability, two with vaginal dryness and two with vaginal atrophy. No Grade two toxicities were reported.Our results confirm that adjuvant HDR vaginal brachytherapy alone in the community setting for stage I and II intermediate risk endometrial carcinoma provides the patient with long-term local control and overall survival and is well-tolerated. This data is consistent with the results of recent published randomized controlled trials.