Abstract
PurposeThis study aimed to evaluate the clinical outcome and efficacy of image-guided interstitial brachytherapy (ISBT) for postsurgical vaginal recurrence of cervical and endometrial cancers.Materials and methodsThe study included 11 patients who received CT-based image-guided high-dose-rate ISBT with or without external beam radiotherapy (EBRT). Local control, progression-free survival, and treatment-related toxicities were evaluated retrospectively.ResultsOf the 11 patients, 4 underwent ISBT with EBRT and the other 7 ISBT alone; two of the latter patients received previous pelvic radiotherapy. After a median follow-up of 43.9 months (range 3.9–92.7 months), the 2-year local control rate was 100%. The median equivalent doses in 2 Gy fractions received by at least 90% of the clinical target volume for ISBT with versus without EBRT were 82.2 Gy (range 60.4–84.2 Gy) versus 69.0 Gy (range 50.8–98.2 Gy). The 2-year progression-free survival rates after ISBT with versus without EBRT were 75% versus 80%, and the difference was not significant (p = 0.74). Grade 3 late toxicities occurred in two patients.ConclusionOur radiotherapy strategy using image-guided ISBT, either with or without EBRT, for postsurgical vaginal recurrence showed effective treatment outcomes.
Highlights
Radical treatment is often indicated for pelvic recurrence of cervical and endometrial cancers
In the patients who did not receive previous pelvic radiotherapy, external beam radiotherapy (EBRT) was administered before interstitial BT (ISBT) when the recurrent tumor was identified at the edge of the vaginal cuff and was suspected to involve microscopic invasion to paravaginal tissues, or if the recurrent tumor was too large to treat with ISBT alone
The tumor site treated with ISBT plus EBRT was the upper one-third of the vagina in all cases
Summary
Radical treatment is often indicated for pelvic recurrence of cervical and endometrial cancers. Radical surgical treatments, such as curative resection or pelvic exenteration, are difficult to perform because of the presence of several organs, such as the rectum, intestines, bladder, and urethra, near the recurrent lesion. Pelvic recurrence, especially isolated vaginal recurrence, can be treated with curative salvage radiotherapy using brachytherapy (BT) [1–3]. In 2013, image-guided HDR interstitial BT (ISBT) was introduced for treating vaginal recurrence at our hospital. The aim of this study was to analyze the clinical results of image-guided HDR ISBT for patients with isolated postsurgical vaginal recurrence of cervical and endometrial cancers, as an initial experience, and to evaluate the efficacy of the treatment
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