Clinical Outcome of Exclusively Radiographer-led Delivery of Postoperative Vaginal Vault Brachytherapy for Endometrial Cancer – The Addenbrooke's Experience

Abstract

AimsPostoperative vaginal vault brachytherapy (VBT) reduces local recurrence in operable endometrial cancer. Radiographer-led delivery of VBT, carried out without image guidance, was implemented at Addenbrooke's in 2010 to maximise skills mix and to improve service delivery. The purpose of this study was to evaluate the safety and effectiveness of this service. Materials and methodsThis was a single-centre retrospective study of endometrial cancer patients treated with postoperative high dose rate VBT ± external beam radiotherapy (EBRT) between January 2010 and December 2016. ResultsIn total, 414 patients were analysed: 307 received adjuvant VBT alone and 107 patients received pelvic EBRT followed by VBT. Thirty-seven per cent of patients receiving VBT alone were high risk according to ESMO-ESGO-ESTRO criteria. After a median follow-up of 59 months (range 2–118), 9/414 (2.2%) patients had isolated vaginal recurrences, 15/414 (3.6%) had locoregional recurrence (vaginal, pelvic node or both), whereas 62/414 (15%) patients had distant recurrence. The 5-year actuarial isolated vaginal recurrence rate was 2.3% (VBT alone 2.1%, EBRT + VBT 3.0%). Grade 3 urinary or bowel toxicity occurred in 2/414 (0.6%) patients treated with EBRT and VBT. None of the patients treated with VBT alone had grade 3 complications. ConclusionRadiographer-led delivery of VBT, without the use of image guidance, is a safe and effective service.