Comparative Results of Vaginal Relapses and Toxicity of 2 Protracted 192-Ir HDR Brachytherapy (BT) Schedules in Postoperative Endometrial Carcinoma (EC)

Abstract

occurred in 17.5% of cases. Median time to progression was 20.7 months (range 2-40.5). By Kaplan-Meier estimate, 3 year vaginal recurrence free survival (RFS) was 95%, pelvis RFS was 94%, distant metastasis free survival was 83.8% and both cancer-specific and overall survival (OS) were 83%. Of variables examined by univariate log-rank analysis, we found only lower stage to be significantly associated with better cancerspecific (90% vs 64%, pZ 0.038) and OS (83% vs 55%, pZ 0.03). Of the two patients observed who progressed, one had distant failure alone and the other presented with vaginal cuff recurrence with progression to omental involvement and positive ascites 10 months later despite salvage radiation and chemotherapy. The five adjuvantly treated patients who progressed had all received radiation alone without chemotherapy. Of these, pattern of failure was comprised of three with simultaneous locoregional (vaginal cuff or pelvic lymphadenopathy; although 3 lacked staging LND) and distant failures, one with vaginal failure with distant metastasis only 3 months later, and one with distant metastasis alone. All patients who progressed had distant failures (either during or after initial recurrence) and eventually died of disease. Distant sites included brain, pleural effusion, bone, positive ascites, inguinal nodes and supraclavicular lymph node. Conclusions: In our report of a large series for a rare cancer we found relatively high rates of distant metastasis despite early stage disease. Recurrences were uniformly fatal and worse outcomes were found in those with stage II disease. Based on patterns of failure, more aggressive systemic therapy may be warranted for those with higher stage disease. Author Disclosure: C.N. Chang-Halpenny: None. S. Natarajan: None. J.M. Hwang-Graziano: None.