Reply

Abstract

Dr. Petereit and Dr. Frederickson in their letter have succinctly summarized the current state of knowledge regarding the role of adjuvant radiotherapy for stage I endometrial carcinoma patients who have been thoroughly staged. They have rightly pointed out that the emerging trend of withholding adjuvant therapy in stage I patients regardless of risk is premature given that the majority of patients in both the GOG 99 and PORTEC trials were in the low-risk category. They have also pointed out that it is equally illogical to continue to prescribe pelvic radiotherapy in high-risk stage I patients who have been thoroughly staged. Our article, together with others, has pointed to the role of vaginal brachytherapy only in high-risk stage I patients with negative lymph nodes. They have rightly pointed out that treating only the upper one-third of the vagina for higher-risk stage I disease may be insufficient to prevent vaginal recurrence, as shown in our article. The role of vaginal brachytherapy only has yet to be investigated in a randomized trial. There are some who question the value of even vaginal brachytherapy. Although the morbidity is low, it still requires hospitalization and resource utilization. Locoregional recurrences were higher in the no-radiotherapy arm for both the GOG 99 and PORTEC trials. However, there was no survival difference. This suggests that locoregional recurrences were amenable to salvage treatment with good survival. Dr. Petereit and Dr. Frederickson have proposed a randomized trial comparing vaginal brachytherapy with pelvic radiotherapy for high-risk stage I patients who are completely staged. Given the evidence from our study and that from the GOG 99 and PORTEC trials, perhaps a more appropriate trial would be to randomize patients with high-risk node-negative stage I endometrial carcinoma to receive either vaginal vault brachytherapy or no adjuvant radiotherapy. We thank Dr. Petereit and Dr. Frederickson for their interest in our article and are grateful for the opportunity to reply.