Abstract
PurposeAbout 3–9% of patients with endometrial cancer are unable to undergo surgery due to medical comorbidities, including morbid obesity, or age-related frailty syndrome. An alternative curative option is irradiation. The aim of this prospective study was to evaluate clinical outcomes of high-dose-rate intracavitary brachytherapy (HDR-ICBT) treatment in such patients. Materials and methodsSeventy-eight patients with FIGO stage I-II endometrial cancer disqualified from surgery were treated with HDR-ICBT with 45–52,5 Gy prescribed to high-risk clinical target volume (HR-CTV) in 5–9 fractions given once a week. All fractions were planned using computed tomography (CT) scans. ResultsThe median follow-up time was 67 months. Median age was 79 years (range: 42–93 years). Median body mass index (BMI) was 39,1 kg/m2 (range: 24,2–68 kg/m2). We observed no statistically significant impact of BMI ≥ 40 on overall survival (OS) or prgression free survival (PFS). The 3- and 5-year OS for the whole population were 69% and 55%, respectively. The impact of high risk features (FIGO II, grade 3 or type 2 cancer) on OS was significant (p = 0,049). The 5-year cumulative incidence of local failure, distant metastases and non-cancer death were 12,9% [95% CI: 5,4%–20,5%], 6,4% [95% CI: 0,9%–11,9%], 33,1% [95% CI: 22,3%–43,9%], respectively. The 5-year risk of cancer and non-cancer death were 9% (95% CI: 3%–16%) and 36% (95% CI: 25%–47%), respectively. We observed G1 vaginal apex stenosis only. ConclusionsCT-guided HDR-ICBT is a feasible and safe management of FIGO stage I endometrial cancer in obese and elderly patients. The survival outcome of the treated group is influenced more by associated comorbidities than by the progression of endometrial cancer.
Published Version
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