Resumen de Three or four fractions per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma: The long-term results on vaginal relapses and toxicity

Izaskun Valduvieco Ruiz, Angeles Rovirosa Casino, Antonio Herreros, Ingrid Romera, I. Ríos, Carlos Ascaso Terrén, A. Sánchez Reyes, Meritxell Arenas Prat, Jaume Pahisa, Alberto Biete Solà

• Background High-dose-rate brachytherapy (HDR-BT) is an accepted part of treatment for endometrial carcinoma and is usually performed in 1¿2 fractions per week using different total doses and doses per fraction. To reduce the overall treatment time, HDR-BT was administered with a 3¿4 days/week schedule.

  Patients and methods From June 2003 to December 2008, 164 patients with stage I-IIIc endometrial carcinoma were treated with HDR-BT (4¿5 Gy per fraction). The patients were divided into two groups; Group 1 (40/164 patients) was treated with HDR-BT alone (6 fractions; 4 fractions/week) and Group 2 (124/164 patients) was treated with both (External Beam Radiotherapy [EBRT] + HDR-BT: 3 fractions/week). Complications were analyzed using RTOG scores for rectum and bladder and the objective scores of LENT-SOMA for vaginal complications.

  Results The mean followup was 48 months. In Group 1, 35 % of patients underwent treatment in ?10 days and 65 % in >10 days. In Group 2, 53.2 % received treatment in ?5 days and in 46.8 % in >5 days. Vaginal relapse was observed in only two patients (1.2 %), both having received adjuvant EBRT + HDR-BT. Acute vaginal toxicity appeared in 8.5 % and late vaginal toxicity in 20.7 % of patients with 13.4 % being G1, 6.7 % G2 and only 0.6 % being G4. No statistically significant differences were found in complications in either brachytherapy group regardless of the overall time.

  Conclusion In our series, three fractions given in 3¿5/days after EBRT or six fractions in 10 days, is a safe regimen in terms of complications and local control.