J Gynecol Oncol.  2017 Nov;28(6):e84. 10.3802/jgo.2017.28.e84.

Impact of vaginal cylinder diameter on outcomes following brachytherapy for early stage endometrial cancer

• Qian JM
• Stahl JM
• Young MR
• Ratner E
• Damast S

• KMID: 2413210
• DOI: http://doi.org/10.3802/jgo.2017.28.e84

Abstract

OBJECTIVE
To examine the outcomes (tolerability, toxicity, and recurrence) of vaginal brachytherapy (VBT) among endometrial cancer (EC) patients treated with small cylinder size.
METHODS
Patients with EC who received adjuvant VBT between September 2011 and December 2015 were reviewed. Patients were fitted with the largest vaginal cylinder they could comfortably accommodate, from 2.0-3.0 cm diameter. Small cylinders were defined as size 2.3 cm or less. Patient, tumor, or treatment characteristics were correlated with need for small cylinders. Treatment tolerability, measures of gastrointestinal (GI), genitourinary (GU), and vaginal toxicity, and rates of recurrence were analyzed.
RESULTS
Three hundred four patients were included. Small cylinders were used in 51 patients (17%). Normal body mass index (BMI; p<0.001), nulligravidity (p<0.001), and shorter vaginal length (p<0.001) were associated with small cylinder size. There was no acute or late grade 3 toxicity. Rates of acute (grade 1-2) GI, GU, or vaginal symptoms were low (10%, 11%, and 19%, respectively). Small cylinder size was associated with increased likelihood of reporting acute GI (p<0.05) but not GU or vaginal symptoms. Small cylinder size was associated with higher risk of grade 1-2 vaginal stenosis (odds ratio [OR]=4.7; 95% confidence interval [CI]=1.5-14.7; p=0.007). There was no association between cylinder size and recurrence rate (p=0.55).
CONCLUSION
VBT is generally very well tolerated, however, patients fitted with smaller cylinders (commonly nulligravid and low BMI) may have increased side effects. Further study to improve the dosimetry of VBT for patients requiring small cylinders may be worthwhile.

Keyword

Endometrial Cancer; Radiation; Vaginal Brachytherapy; Toxicity; Vaginal Stenosis

MeSH Terms

Adenocarcinoma/*radiotherapy
Adult
Aged
Aged, 80 and over
Body Mass Index
Brachytherapy/*instrumentation
Constriction, Pathologic
Databases, Factual
Endometrial Neoplasms/*radiotherapy
Female
Gastrointestinal Diseases/*epidemiology
Gravidity
Humans
*Hysterectomy
Lymph Node Excision
Middle Aged
Neoplasm Staging
Ovariectomy
Radiation Injuries/*epidemiology
Radiotherapy, Adjuvant/*instrumentation
Salpingectomy
Treatment Outcome
Vagina
Vaginal Diseases/*epidemiology