Brachytherapy for Elderly Women with Gynecologic Cancer; Single Institutional Experience

Abstract

To describe toxicity and disease outcomes in women ≥70 years old with gynecologic cancers treated with brachytherapy. We conducted an IRB approved, single-institution retrospective review of women ≥70 years old with gynecological cancers consecutively treated with intracavitary and/or interstitial brachytherapy (BT) from 2000-2019. Cancer, treatment characteristics, time to locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) from date of biopsy, Charleston comorbidity score (CCI), and toxicity were collected. Descriptive statistics were calculated and survival was analyzed by Kaplan-Meier (KM) method with log-rank testing to determine significance for univariate analysis. Of the 39 women identified, 21 (54%) were 70-79 years old and 18 (46%) were ≥80 years old. The majority had stage I-II cancers (n = 23, 59%) and 16 (41%) had stage III-IV cancers, with cervical cancer the most common primary (n = 31, 79%), followed by endometrial (n = 4, 10%) and vaginal/vulvar (n = 4, 10%) cancers. BT technique was intracavitary in 19 (49%) and interstitial in 20 (51%). Thirty-four (87%) received BT for primary treatment with or without external beam radiotherapy, and 5 (13%) at time of progression/recurrence. Fifteen (38%) women were treated using 2D planning, while the remainder used CT-based planning. Median follow-up was 30 months for all patients (3-177 months) At the time of analysis, 31 patients (79%) had died, 6 (15%) were alive, and 2 (5%) were lost to follow-up. Median OS by KM was 40 months. Median OS was 22 months for women ³80 and 59 months for women 70-79 (p<0.001). Median OS was 52 months for CCI <5 and 22 months for CCI ≥5 (p = 0.005). Median OS was 50 months in patients without documented recurrence and 29 months for patients who recurred (p = 0.022). Overall local control (LC) was 87% with 2 (5%) LRR, 7 (18%) DM, and 3 (8%) with both LRR and DM. Of the 5 LRR, 3 were vaginal/vulvar, and 2 were cervical primary disease sites. Patients with LRR had a lower average CCI 4.2 vs. 4.9 than those without LRR. Time to DM was shorter for vaginal/vulvar cancers (p = 0.013) and OTT >56 days (p = 0.006). Patients with DM had a lower average CCI 4.3 vs. 5.0 than those without DM. Thirteen patients (33%) experienced grade 3 toxicities including 8 (24%) acute and 7 (18%) late toxicities, there were no grade ≥4 toxicities. Elderly women with gynecological cancers treated with brachytherapy tolerated treatment well with no grade ≥4 toxicities recorded and excellent LC. While CCI ≥5 was a significant predictor for shorter OS, it was not associated with higher rates of LRR nor DM.