Resumen de Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients

I. Ríos, Angeles Rovirosa Casino, Carlos Ascaso Terrén, Izaskun Valduvieco Ruiz, Antonio Herreros, L. Castilla, Sebastià Sabater, K. Holub, Jaume Pahisa, Alberto Biete Solà, Meritxell Arenas Prat

• Purpose To analyze the vaginal-cuff local control (VCC) and toxicity in postoperative endometrial carcinoma patients (EC) underwent high-dose-rate brachytherapy (HDR-BT) administered daily.

  Materials and methods 154 consecutive patients received postoperative HDR-BT for EC from January 2007 to September 2011. FIGO-staging I–IIIC2 patients were divided into two groups according to risk classification: Group 1 (94/154) included high-risk or advanced disease patients and Group 2 (60/154) included intermediate-risk EC patients. Group 1 underwent external beam irradiation (EBI) plus HDR-BT (2 fractions of 5 Gy) and Group 2 underwent HDR-BT alone (4 fractions of 5 Gy). Toxicity evaluation was done with RTOG scores for bladder and rectum, and the objective criteria of LENT–SOMA for vagina.

  Results With a median follow-up of 46.7 months (36.6–61 months) only two patients developed vaginal-cuff recurrence in Group 1 (2.1 %) and none in group 2 (0 %). Early toxicity in Group 1 appeared 5.3 % in rectum, 7.5 % in bladder (G1–G2) and 2.1 % in vagina (G1); late toxicity was present in 7.3 % in rectum (all G1–G2 but 1 G3) and in 27.7 % in vagina (all G1–G2 but one G4). In Group 2, 6.7 % developed acute G1–G2 bladder and 6.6 % acute vaginal (G1–G2) toxicity. No late rectal or bladder toxicity was observed; 21.7 % of G1–G2 presented late problems in vagina.

  Conclusions The present HDR-BT schedule of 2 fractions of 5 Gy after EBI and 4 fractions of 5 Gy administered daily showed excellent results in terms of VCC and toxicity.