Radiat Oncol J.  2016 Dec;34(4):265-272. 10.3857/roj.2016.01648.

Treatment outcomes after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer

• Kim J
• Lee KJ
• Park KR
• Ha B
• Kim YJ
• Jung W
• Lee R
• Kim SC
• Moon HS
• Ju W
• Kim YH
• Lee J

• KMID: 2366047
• DOI: http://doi.org/10.3857/roj.2016.01648

Abstract

PURPOSE
The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma.
MATERIALS AND METHODS
The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0-50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week.
RESULTS
The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture.
CONCLUSION
Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

Keyword

Endometrial cancer; Intracavity radiotherapy; Conformal radiotherapy; Adjuvant radiotherapy

MeSH Terms

Brachytherapy
Disease-Free Survival
Endometrial Neoplasms*
Female
Follow-Up Studies
Fractures, Stress
Gynecology
Humans
Obstetrics
Pelvic Bones
Pelvis
Radiotherapy
Radiotherapy, Adjuvant*
Radiotherapy, Conformal
Recurrence
Risk Factors