Abstract
PurposeTo evaluate the preliminary results of the use of 68 Gy EQD2(α/β=3 Gy) as a dose limit to the lowest dose in the most exposed 2 cm3 of the vagina in order to reduce G2 late vaginal problems in postoperative endometrial carcinoma (EC).MethodsFrom November 2016 to October 2019, 69 postoperative EC patients receiving vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) were prospectively analyzed. The median EBRT dose was 45 Gy (range: 44–50.4 Gy), 1.8−2 Gy/day, 5 fractions(Fr)/week. VBT was administered with the following schedule: 1Fr of 7 Gy after EBRT and 2 daily Fr × 7.5 Gy in exclusive VBT. The dose was prescribed at 0.5 cm from the applicator surface with an active length of 2.5 cm; 56 patients were treated with vaginal cylinders (49–3.5 cm, 6–3 cm, and 1–2.5 cm) and 13 with the colpostat technique. The overall VBT dose was adjusted to meet the vaginal restriction of < 68 Gy EQD2(α/β=3 Gy) at 2 cm3. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum, and the objective LENT-SOMA criteria for vagina.ResultsWith a median follow-up of 31.0 months, no vaginal-cuff recurrences were found. Late toxicity: only 1G1(1.4%) rectal toxicity; 21G1(30.4%) and 3G2(4.3%) vaginal complications. Only one (1.4%) of 3 G2 manifested as vaginal shortening.ConclusionsIn postoperative EC patients treated with VBT, only one developed G2 vaginal stenosis with the use of 68 Gy EQD2(α/β=3 Gy) as a dose constraint. These preliminary results seem to indicate the value of this dose limit for reducing G2 vaginal stenosis. Nonetheless, these findings should be confirmed in a larger number of patients with longer follow-up.
Highlights
Endometrial cancer is a common neoplasm in developed countries
Adjuvant vaginal brachytherapy (VBT) is a well-established treatment, aimed at preventing tumor recurrence, with a vaginal-cuff from 15 to 2% or less according to the series
Since 2003 patients with intermediate-risk have been treated with exclusive VBT at Hospital Clinic of Barcelona, with 0% of vaginal-cuff recurrence and less than 2% when VBT was associated with external beam radiotherapy (EBRT)
Summary
Endometrial cancer is a common neoplasm in developed countries. In Spain, it is the fourth most frequent neoplasm in women and the first of the female genital tract, with an estimated 6784 new cases and 1660 deaths in 2018. Despite the increase in incidence, the mortality rate has decreased in Europe. Most of these neoplasms develop in postmenopausal women, with a mean age of 60 years, and the diagnosis is usually achieved in early stages considering that the most common manifestation is metrorrhagia [1, 2]. The present study has been partially presented in part as a poster in the ESTRO 2021 meeting in Madrid, Spain. Extended author information available on the last page of the article
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