Radiotherapy as local adjuvant treatment for endometrial carcinoma--a review of 45 patients (original) (raw)
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Gynecologic Oncology, 1997
Purpose. To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachyther-Cancer of the uterus remains the most common gynecoapy (HDRB) and external beam radiotherapy (EBRT) for patients logical malignancy in the 1990s with an estimated 34,000 found to have isolated vaginal recurrences from early-stage endocases in 1996 in the United States [1]. The cornerstone of metrial adenocarcinoma following total abdominal hysterectomy treatment for early-stage endometrial carcinoma (i.e., FIGO and bisalpingo-oophorectomy (TAH BSO).
Brachytherapy, 2015
OBJECTIVE: To evaluate recurrence patterns and overall survival in patients treated with adjuvant radiation after surgical staging for Stage II endometrial carcinoma. Secondary goals include identification of prognostic factors for recurrence and toxicity assessment. METHODS/MATERIALS: The medical records of 41 patients treated with adjuvant radiotherapy at Washington University School of Medicine after surgical staging for endometrial cancer (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, lymph node dissection) were reviewed. Nineteen were treated with a combination of external beam radiotherapy and vaginal brachytherapy (VB), and 22 patients were treated with postoperative VB alone. Median followup for all patients was 41 months. RESULTS: Median patient age was 59 years (range, 42e87 years). All tumors were of endometrioid histology. There were 20 Grade 1 tumors, 13 Grade 2 tumors, and 8 Grade 3 tumors. For all patients, the 5-year overall survival was 69.8%, and the 5-year recurrence-free survival was 89.0%. There was no statistically significant difference in overall survival ( p 5 0.510) or freedom from vaginal ( p 5 0.840), distant ( p 5 0.133), or any recurrence ( p 5 0.275) with respect to modality of treatment (external beam radiotherapy and VB vs. VB alone). There were no pelvic lymph node recurrences. In the univariate analysis, there were no risk factors influencing overall survival or recurrences. One patient experienced a toxicity requiring hospital admission. She was treated with pelvic external beam radiation plus brachytherapy. CONCLUSIONS: VB alone results in excellent local control for patients with Stage II endometrial cancer after surgical staging. Long-term toxicities are rare and more common in the group of patients who were treated with pelvic external beam plus brachytherapy. Ó
Journal of Contemporary Brachytherapy, 2017
Purpose: This study was designed to retrospectively analyze outcomes of high-dose-rate (HDR) brachytherapy, with or without external beam radiotherapy (EBRT), in patients with vaginal recurrence of endometrial carcinoma, and to identify factors prognostic of patient outcomes. Material and methods: The medical records of all patients who underwent HDR brachytherapy for initial recurrence in the vagina of endometrial cancer after definitive surgery between 1992 and 2014 were retrospectively reviewed. All patients underwent either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT) with or without EBRT. Late toxicity was graded using the EORTC (LENT/SOMA) scale, revised in 1995. Results: Thirty-seven patients were identified. The median follow-up time was 48 months (range: 6-225 months). Of these 37 patients, 23 underwent ICBT, 14 underwent ISBT, and 26 underwent EBRT. Tumor size at first examination of initial relapse was significantly larger in the ISBT than in the ICBT group. The 4-year respective overall survival (OS), local control (LC), and progression-free survival (PFS) rates in the entire cohort were 81.0%, 77.9%, and 56.8%, respectively. The interval between diagnosis of first recurrence and radiotherapy (< 3 months, ≥ 3 months) was a significant predictor of LC and PFS. OS and LC rates did not differ significantly in the ICBT and ISBT groups. Two patients experienced grade 2 rectal bleeding, and four experienced grade 2 hematuria. No grade 3 or higher late complications were observed. Conclusions: Salvage HDR brachytherapy is an optimal for treating vaginal recurrence of endometrial carcinoma with acceptable morbidity. Early radiotherapy, including brachytherapy, should be considered for women who experience vaginal recurrence of endometrial cancer.
International Journal of Radiation Oncology Biology Physics, 1998
Purpose: To retrospectively evaluate the outcome and risk factors in patients treated with radiation for endometrial cancer at time of recurrence. Materials and Methods: Three hundred ninety-nine women were treated with radiation therapy for endometrial cancer at KCI/WSU from January 1980 to December 1994. Of these, 26 patients treated primarily with surgery received radiation therapy at the time of recurrence. Median time to recurrence after surgery was 8 months, with all recurrences occurring within 24 months. Twenty-four patients had recurrences in the vaginal cuff, vagina, or pelvis. These patients received external-beam radiation to the pelvis (45.00 -50.40 Gy) and periaortic lymph nodes (45.00 -50.00 Gy), along with a boost given by external-beam radiation or brachytherapy (16.00 -30.00 Gy). Mean follow-up was 15 months (range 1-85 months).
Long-term results of adjuvant radiotherapy in stage I endometrial cancer
2011
Two hundred sixty-three patients with stage I endometrial adenocarcinoma, who were treated with postoperative radiotherapy between 1978 and 1998, were analyzed retrospectively. According to the 1988-FIGO staging system, the disease was stage IA in 19, stage IB in 128, and stage IC in 116 patients. One hundred and ninety-seven patients were treated with external and intracavitary irradiation, 45 patients with external radiotherapy and 21 patients with vaginal brachytherapy.
Indications for Adjuvant Radiotherapy in Endometrial Carcinoma
Hematology/Oncology Clinics of North America, 1999
Stage for stage, endometrial cancer has about the same prognosis as cervical cancer.65 In general, this prognosis is good, because endometrial cancer is usually diagnosed at an early stage and has a low tendency for micrometastatic seeding. The survival rate is provided by the Swedish population-based Cancer Registry, which registered 23,970 patients with diagnoses of endometrial cancer between 1960 and 1989. During this time, a modest change was seen with a 5-year relative survival rate of 75% (95% confidence interval [CI] of 73% to 78) for patients (n = 1966) diagnosed between 1960 and 1962, and 82% (95% CI of 80% to 84%) for patients (n = 2605) diagnosed between 1987 and 1989 (unpublished data). Also, the 5-year cancer-specific survival rate of 13,040 patients diagnosed with endometrial cancer at 117 institutions between 1987 and 1989 was 77Y0.~~ The same report showed that about 15% of patients with stage I endometrial cancer die of disease within 5 years.
Vaginal vault recurrences of endometrial cancer in non-irradiated patients — Radiotherapy or surgery
Gynecologic Oncology Reports, 2015
Background: The treatment of locally recurrent endometrial cancer is based on limited evidence. The standard treatment is radiotherapy (RT) which is effective for local control and the effect has been documented in prospective studies. Investigations of surgical treatment (ST) of recurrences are few and limited to previously irradiated patients or patients with advanced disease. Investigation of surgical treatment for isolated vaginal vault recurrence is practically nonexistent. The aim of this study is to evaluate the efficacy of RT and ST in a nonirradiated group with recurrent endometrial cancer limited to the vaginal vault. Methods: Patients treated for recurrent endometrial cancer at Odense University Hospital, Denmark between 2003 and 2012 were identified, n = 118. Thirty-three patients had an isolated vaginal vault recurrence and were treated with either RT, ST or both. Re-recurrence rates and survival rates were calculated at 2 year follow-up using Fishers exact test. Results: Twenty-six patients were treated with RT, 5 with ST, 2 with both. The mean (SD) follow-up-time was 4.4 years (2.99) (RT) and 3.9 years (0.90) (ST). Two year re-recurrence rates were 40% (RT) (95 CI 9.2-48%) and 0% (ST) (95 CI 0-60%). Two-year survival rates were 83% (RT) (95 CI 71-100%) and 100% (ST) (95 CI 40-100%) ST had one re-recurrence at 2.3 years. Conclusion: This study indicates that ST is an appropriate treatment for locally recurrent endometrial cancer. Our study involves a limited number of patients and is made retrospectively, therefore prospective and ideally randomized trials evaluating both survival and complications are warranted.
Journal of contemporary brachytherapy, 2018
Randomized trials on the effect of external beam radiotherapy (EBRT) with or without vaginal brachytherapy (VBT) for endometrial carcinoma are very few. In view of this, the current study was conducted with the hypothesizes: whether the escalated dose of 26 Gy (VBT alone) in comparison with various major international trials (PORTEC-2) has any difference in rates of disease-free and overall survival with fewer adverse effects in low resource setting like India. An open-labeled, non-inferiority, randomized control trial was undertaken at a regional cancer center among patients with stage IA or IB high-intermediate risk endometrial carcinoma. A total of 50 patients were divided equally among two arms of combined EBRT with VBT (arm I) and VBT alone (arm II). A dose of 50-50.4 Gy in 25-28 fractions of EBRT with 2 fractions of VBT 6.5 Gy each were delivered to patients in arm I and 4 fractions of VBT 6.5 Gy each to patients in arm II, and were followed up for 60 months. During the median...