Brachytherapy alone in the postoperative treatment of stage I endometrial carcinoma

Abstract

Introduction: This study evaluate the local control efficacy and toxicity of postoperative intravaginal brachytherapy (IVBT) alone among patients with endometrial cancer stage I. Material and methods: Between January-2004 and December-2011, 60 stage I endometrial adenocarcinoma patients were treated with IVBT alone, 47 in stage IA, 13 patients in stage IB. The surgical approaches were total abdominal hysterectomy (HTA) and bilateral salpingoopforectomy (BSO) in 45 patients, plus bilateral pelvic, paraaortic lymph node dissection in 15 patients. The mean interval between the surgery and the brachytherapy was 30-37 days. <½ miometrial invasion was found in 48 patients, and >½ in 12 patients. The brachytherapy was applied in 3 weekly fractions of 7Gy per fraction, prescribed at depth of 0,5cm from the applicator surface with HDR, Iridium-192. The mean diameter of the vaginal applicator was 3 (2-3,5) cm. Results: With a mean follow up time of 38 months (12-84), all 60 patients are alive. Reccurence was observed in 5 patients (8,3%): 3 patients experienced local recidiv and 2 patients developed a pelvic mass. The mean rectal dose was estimated 14,1Gy and the mean bladder dose was 13Gy. Acute genitourinary toxicity was observed in 31 patients during the therapy. Vaginal stenosis as late complication occurred in 3 patients. Conclusion: Intravaginal brachytherapy alone in the postoperative treatment of stage I endometrial carcinoma achieves local control associated with acceptable toxicity and minimal morbidity.