Intravaginal Radiation Research Articles

Ovarian survival after pelvic radiation: transposition until the age of 35\xa0years

PurposeTo evaluate the effectiveness of ovarian transposition (OT) prior to radiation therapy (RT) and to evaluate the effect of age on ovarian survival (OS) after OT.MethodsWe performed a retrospective control study, with women (aged < 45 years) who underwent OT prior to pelvic radiation, versus women diagnosed with cervical cancer and treated with hysterectomy/trachelectomy and radiation therapy. All women were treated between 1989 and 2010. The 5 years OS rate was calculated, with a sub-analysis for age (25–30; 31–35 and 36–40 years). Ovarian failure was defined as climacteric complaints (with or without starting hormone replacement therapy) and/or laboratory measurements (FSH > 40 IU/L and/or estradiol < 100 pmol/L), or bilateral salpingo oophorectomy. Women were censored at recurrence.ResultsTwenty-seven women after OT and 29 controls were included. The radiation dose was 44.8 Gy (25.0–63.0 Gy) and 46.3 Gy (45.0–50.0 Gy), respectively. The 5-year ovarian survival rate was 60.3% versus controls 0% (p < 0.001 95% CI 3.48–11.50). Despite the decrease in ovarian survival after OT with increasing age, in all age groups (25–30, 30–35 and 35–40) ovarian survival after OT was significantly better compared to women without OT (p = 0.001; p = 0.004 and p = 0.000, respectively). Neither intra-vaginal radiation therapy of concomitant chemotherapy in addition to pelvic radiation significantly altered ovarian survival.ConclusionsOur data shows that ovarian transposition prior to pelvic radiation is effective in women until the age of 35 years and needs to be discussed in patients aged 36–40 years.

Comparison of Early-Stage Uterine Papillary Serous Carcinoma (UPSC) and Carcinosarcoma Treated With Adjuvant Carboplatin/Taxane Chemotherapy and Intravaginal Radiation Therapy (IVRT)

Comparison of Early-Stage Uterine Papillary Serous Carcinoma (UPSC) and Carcinosarcoma Treated With Adjuvant Carboplatin/Taxane Chemotherapy and Intravaginal Radiation Therapy (IVRT)

Patterns of relapse in stage I–II uterine papillary serous carcinoma treated with adjuvant intravaginal radiation (IVRT) with or without chemotherapy

ObjectiveTo evaluate patterns of relapse in early stage uterine papillary carcinoma (UPSC) patients receiving adjuvant intravaginal radiotherapy (IVRT) with or without chemotherapy. MethodsFrom 1/1996 to 12/2010, 77 women with stage I–II UPSC underwent surgery followed by IVRT (median 21Gy). Stage IA patients without residual disease at surgery were excluded. IVRT and chemotherapy (carboplatin/taxane) was given to 61 (79%) patients and IVRT alone to 16 (21%). The median follow-up was 62months for surviving patients. ResultsOf the 77 patients, 11 (14%) relapsed as follows: vaginal 2 (3%), pelvic 5 (6%), para-aortic 5 (6%), peritoneal 6 (8%), and other distant sites 8 (10%). Of the 5 pelvic relapses, 2 were isolated and were salvaged. In those treated without chemotherapy, only 1/16 developed recurrence (mediastinal). The 5-year vaginal, pelvic, para-aortic, peritoneal, and distant recurrence rates were 2.7% (C.I. 0–6.2%), 5.8% (C.I. 0.6–11.0%), 5.4% (C.I. 0.6–10.1%), 5.3% (C.I. 0.5–10.1%) and 6.6% (C.I. 1.4–11.8%), respectively. The 5-year disease-free survival (DFS), and overall survival (OS) were 88% (C.I. 81–95%), and 91% (C.I. 84–97%), respectively. The only predictor of worse 5-year pelvic control was stage (96.2% stage IA vs 87.7% for stage IB-II, p=0.043). ConclusionsIn stage I–II UPSC patients who predominantly receive adjuvant chemotherapy, IVRT as the sole form of adjuvant RT provides excellent locoregional control. The risk of isolated pelvic recurrence is too low to warrant routine use of external pelvic RT.

Patterns of Relapse in Stage I-II Uterine Papillary Serous Carcinoma Treated With Adjuvant Intravaginal Radiation (IVRT)

IVRT is becoming the preferred form of adjuvant RT in early stage endometrial cancer. Whether such treatment is sufficient for high-risk histology, such as uterine papillary serous (UPS) remains debatable. The purpose of this study is to report a single institution experience using IVRT as the sole form of adjuvant RT in early stage UPS.

Five-year outcomes of adjuvant carboplatin/paclitaxel chemotherapy and intravaginal radiation for stage I–II papillary serous endometrial cancer

ObjectiveThe purpose of this study is to report our single-institution experience with concurrent adjuvant intravaginal radiation (IVRT) and carboplatin/paclitaxel chemotherapy for early stage uterine papillary serous carcinoma (UPSC). MethodsFrom 10/2000 to 12/2009, 41 women with stage I–II UPSC underwent surgery followed by IVRT (median dose of 21Gy in 3 fractions) and concurrent carboplatin (AUC=5–6) and paclitaxel (175mg/m2) for six planned cycles. IVRT was administered on non-chemotherapy weeks. The Kaplan–Meier method was used to estimate survival, and the log-rank test was used for comparisons. ResultsMedian patient age was 67years (51–80years). Surgery included hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, omental biopsy, and pelvic and paraaortic lymph node sampling. FIGO 2009 stage was IA in 73%, IB in 10%, and II in 17%. Histology was pure serous in 71% of cases. Thirty-five patients (85%) completed all planned treatment. With a median follow-up time of 58months, the 5-year disease-free (DFS) and overall survival (OS) rates were 85% (95%CI, 73–96%) and 90% (95%CI, 80–100%). The 5-year pelvic, para-aortic, and distant recurrence rates were 9%, 5%, and 10%, respectively. There were no vaginal recurrences. Of the 4 pelvic recurrences, 2 were isolated and were successfully salvaged. Patients with stage II disease had lower DFS (71% vs. 88%; p=0.017) and OS (71% vs. 93%; p=0.001) than patients with stage I disease. ConclusionsConcurrent adjuvant carboplatin/paclitaxel chemotherapy and IVRT provide excellent outcomes for early stage UPSC. Whether this regimen is superior to pelvic radiation will require confirmation from the ongoing randomized trial.

Comparative patient-centered outcomes (health state and adverse sexual symptoms) between adjuvant brachytherapy versus no adjuvant brachytherapy in early-stage endometrial cancer.

9104 Background: We performed a cross-sectional analysis of survivors of stage I endometrial cancer (EC) to examine the relationship between receipt of adjuvant intra-vaginal radiation therapy (IVRT), health state (HS), and sexual functioning (SF). Methods: Survivors were administered anonymous questionnaires containing demographic and treatment-related items, the EQ5D to measure current HS, and the Female Sexual Function Index (FSFI) to measure current SF. All were disease-free and had undergone simple hysterectomy (SH) with or without adjuvant IVRT at least one year prior to questionnaire completion. None had received chemotherapy or hormonal therapy. The study was IRB-approved under a waiver of consent. The primary endpoint was a comparison of EQ5D-health states and FSFI scores between survivors who had received SH alone and those who had received SH and adjuvant IVRT. Fisher’s exact test was used to compare IVRT and no-IVRT groups and multivariate regression was applied to find associations between factors and the outcome measures. Results: 136 (66.3%) participants had undergone SH alone and 69 (33.7%) had undergone SH and adjuvant IVRT. The SH alone group was younger; otherwise, the two groups were balanced with respect to ethnicity, marital status, education level, medical co-morbidities (diabetes, hypertension, anxiety), type of SH (laparotomy vs minimally invasive surgery-MIS), and baseline sexual activity. In the IVRT and no-IVRT groups, the median EQ5D-health states were 88 (range 40-100) and 85 (range 10-100) respectively, and the median FSFI scores were 14.1 (range 1.2-35.4) and 16.5 (range 1.2-34.8) respectively. Controlling for age and type of SH, receipt of IVRT was associated with better HS (p=0.018) and not associated with poorer SF (p=0.1399). Receipt of laparotomy (vs MIS) was associated with poorer HS and worse SF (p=0.0156 and p=0.0115, respectively), and its detrimental effect on FSFI score was more pronounced in the IVRT compared to no-IVRT group (p=0.0486). Conclusions: Compared to SH alone, receipt of adjuvant IVRT was generally not associated with poorer SF or HS.

Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

We used the Female Sexual Function Index (FSFI) to investigate the prevalence of sexual dysfunction (SD) and factors associated with diminished sexual functioning in early stage endometrial cancer (EC) patients treated with simple hysterectomy and adjuvant brachytherapy. A cohort of 104 patients followed in a radiation oncology clinic completed questionnaires to quantify current levels of sexual functioning. The time interval between hysterectomy and questionnaire completion ranged from <6 months to >5 years. Multivariate regression was performed using the FSFI as a continuous variable (score range, 1.2-35.4). SD was defined as an FSFI score of <26, based on the published validation study. SD was reported by 81% of respondents. The mean (± standard deviation) domain scores in order of highest-to-lowest functioning were: satisfaction, 2.9 (± 2.0); orgasm, 2.5 (± 2.4); desire, 2.4 (± 1.3); arousal, 2.2 (± 2.0); dryness, 2.1 (± 2.1); and pain, 1.9 (± 2.3). Compared to the index population in which the FSFI cut-score was validated (healthy women ages 18-74), all scores were low. Compared to published scores of a postmenopausal population, scores were not statistically different. Multivariate analysis isolated factors associated with lower FSFI scores, including having laparotomy as opposed to minimally invasive surgery (effect size, -7.1 points; 95% CI, -11.2 to -3.1; P<.001), lack of vaginal lubricant use (effect size, -4.4 points; 95% CI, -8.7 to -0.2, P=.040), and short time interval (<6 months) from hysterectomy to questionnaire completion (effect size, -4.6 points; 95% CI, -9.3-0.2; P=.059). The rate of SD, as defined by an FSFI score <26, was prevalent. The postmenopausal status of EC patients alone is a known risk factor for SD. Additional factors associated with poor sexual functioning following treatment for EC included receipt of laparotomy and lack of vaginal lubricant use.

Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

Prognostic Factors for Sexual Dysfunction among Endometrial Cancer Patients Treated with Simple Hysterectomy and Adjuvant Intravaginal Radiation Therapy

Simple hysterectomy followed by intravaginal radiation therapy (IVRT) is a common treatment for early stage endometrial cancer (EC). Yet, there is little research on sexual functioning (SF) after such treatment. We investigated the prevalence of sexual dysfunction and factors associated with worse SF in EC patients followed routinely in a radiation oncology clinic.

Concurrent carboplatin/paclitaxel and intravaginal radiation in surgical stage I–II serous endometrial cancer

Objective To report a single institution experience in surgical stage I–II serous endometrial cancer using combined carboplatin/paclitaxel and intravaginal radiation (IVRT). Methods Between 10/00 and 12/06, 25 stage I–II patients with serous endometrial cancer were treated at our institution with surgery, postoperative IVRT, and concurrent chemotherapy (CT). Results The mean age was 67 years old (range, 53–80 years). Surgery consisted of hysterectomy (TAH/BSO, 64%, LAVH/BSO, 36%), peritoneal washing, omental biopsy, and pelvic lymph-node dissection (median 14 nodes). Para-aortic node sampling was done in 88% (median, 6). IVRT median dose was 21 Gy (range, 18–21 Gy, in 3 fractions) and concurrent CT consisted of carboplatin to AUC = 5 and taxol to 175 mg/m 2 given every 3 weeks for 6 cycles. CT was well tolerated with 22/25 (88%) receiving 6 cycles. Three patients received ≤ 5 cycles; 2 owing to physician preference (3 and 4 cycles) and 1 owing to toxicity (5 cycles). Only 1 patient (4%) had grade 3 toxicity (abscess). Grade 2 neurotoxicity was seen in 5 patients (20%). All patients finished their IVRT as scheduled, and there was no grade 3 toxicity. With a median follow-up of 30 months, the 5-year progression-free and overall survival rate was 88%. None of the patients developed vaginal recurrence. Conclusions Based on this study, surgical staging followed by IVRT and carboplatin/paclitaxel is well tolerated and effective in stage I–II serous endometrial cancer. Confirmation of these results on a larger number of patients with longer follow-up is still needed.

A retrospective assessment of outcomes of chemotherapy-based versus radiation-only adjuvant treatment for completely resected stage I–IV uterine carcinosarcoma

PurposeTo determine the progression-free survival (PFS) and overall survival (OS) in a cohort of patients who received either platinum-based chemotherapy with or without radiation therapy (pelvic or WAI), or RT alone. MethodsMemorial Sloan-Kettering Cancer Center (MSKCC) electronic medical records from 8/1/1995 to 10/3/2007 were reviewed for patient age, diagnosis date, type of primary surgery, residual disease at the completion of primary surgery, FIGO stage, treatment details, dates of progression and death, and site(s) of first recurrence. PFS and OS by stage (I/II v III/IV) and by treatment type (chemotherapy with or without RT v RT alone) were determined using landmark analyses 8 weeks after surgery. Patients who received chemotherapy with or without RT (pelvic or abdominal) or RT alone (pelvic or abdominal) were included in the analysis. Both groups were allowed to have received intravaginal radiation therapy (IVRT). ResultsForty-nine patients met study criteria. Thirty-eight/49 patients received chemotherapy: 23/38 (60.5%) received paclitaxel-carboplatin; 7/38 (18.4%) received ifosfamide-platinum; 8/38 (21.0%) received other chemotherapy. FIGO stage was: I=15 (31%); II=5 (10%); III=21 (43%); IV=8 (16%). Three-year PFS for the entire cohort was 24%. Three-year OS for the entire cohort was 60%. Three-year median PFS time for the entire cohort was 15 months (95% CI: 11–25 months). Three-year median OS time for the entire cohort was 67 months (95% CI: 23–89 months). Three-year PFS for stages I–II was 43% v 14% for stages III–IV (HR=1.98 [0.9–4.33]); P=0.082. Three-year OS for stages I–II was 68% v 55% for stages III–IV (HR=1.26 [0.47–3.41]); P=0.648. Three-year PFS for chemotherapy with or without RT was 35% v 9% for RT alone (HR=1.74 [0.79–3.85]); P=0.164. Three-year OS for chemotherapy with or without RT was 66% v 34% for RT alone (HR=2.02 [0.77–5.33]); P=0.146. ConclusionsOur study corroborates GOG 150 results, and shows that paclitaxel-carboplatin appears to be an efficacious adjuvant chemotherapy regimen for completely resected uterine carcinosarcoma. The role of adjuvant RT in addition to chemotherapy warrants further investigation.

Stage IB Endometrial Cancer

The role of surgical lymph node dissection and adjuvant radiation therapy (RT) in early stage endometrial cancer is no longer clearly defined. The increased appreciation of lymphadenectomy and the absence of survival advantage from adjuvant RT rise controversies how patients should adequately be treated in stage IB endometrial cancer. The aim of this review is to rule out the validity of either treatment option and determine which preference provides the best therapeutic benefit. Reports of relevant studies obtained from a search of PubMed and studies referenced in those reports were reviewed. Based on the available data in the literature, for stage IB grade 1 or 2, the risk of pelvic relapse is considered too low to justify pelvic RT. However, intravaginal RT (IVRT) should be recommended for those ≥ 60 years old or with lymphovascular invasion (LVI). For patients with stage IB grade 3 (and IC all grades), the treatment recommendation is mainly based on whether surgical lymph node staging was performed. These patients have – without surgical lymph node staging – a high risk of pelvic recurrence and should therefore primarily undergo relaparotomy for lymphadenectomy or pelvic RT as second choice. If these patients had a surgical lymph node staging, then IVRT alone is a reasonable alternative to pelvic RT. Overall survival may not be the only ideal endpoint for stage IB endometrial cancer since causes of death are mostly other than endometrial cancer. Conventional pelvic RT may be overtreatment in some patients, in particular in those patients with a large number of negative lymph nodes after lymphadenectomy. However, negative surgical staging should not be understood as adjuvant RT can be omitted in all patients.

Twelve-year experience in the management of endometrial cancer: A change in surgical and postoperative radiation approaches

Over the past 12 years, the primary management of endometrial cancer at a comprehensive cancer center has undergone changes characterized by the increased use of laparoscopic surgery with comprehensive staging resulting in a decreased reliance on postoperative adjuvant whole pelvic radiation therapy (WPRT). The purpose of this study was to analyze the results of these changes. Between 1/93 and 12/04, 1312 patients underwent surgery for endometrial cancer consisting of either abdominal or laparoscopic hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO or LAVH/BSO). Pelvic and para-aortic lymph node dissection was performed at the discretion of the attending physician. Postoperative adjuvant treatment employed in patients with high-risk features consisted mainly of WPRT+/-intravaginal radiation therapy (IVRT). Total direct medical charges incurred from 10 days prior to surgery through 75 days after surgery were determined with charges converted to direct medical costs, taking into account inflationary changes. The median age at diagnosis for all patients was 62 years (range, 21-93 years), with a median follow-up of 31.6 months (range, 0-140 months). There was a significant increase in LAVH/BSO versus TAH/BSO (P<0.001) until 2001 when we began participating in a national randomized trial of laparoscopic versus abdominal surgery. In addition, there was a significant increase in the percentage of patients undergoing lymph node dissection as well as the median number of nodes removed (P<0.001). This was associated with a significant decrease in the use of WPRT during 1993-1998 versus 1999-2004 (P<0.001). The use of IVRT remained the same during these time periods. There was no significant difference in 1-, 2-, or 5-year survival for patients treated in either time period. Cost data were available from 1995 to 2004. There was a significant increase in the median total direct medical costs when comparing periods 1995-1998 with 1999-2004 (P<0.001), although the median cost of pelvic radiation therapy was lower in the later time period. Over a 12-year period, the primary management of endometrial cancer changed to include an increased use of laparoscopy and comprehensive surgical staging and a decrease in the use of postoperative adjuvant WPRT, with no appreciable negative effect on overall survival.

When and How Should Adjuvant Radiation Be Used in Early Endometrial Cancer?

The role of adjuvant radiation therapy (RT) in early endometrial cancer is no longer clearly defined. The increased use of surgical lymph nodes staging and the perceived "lack of survival advantage" with adjuvant pelvic RT leads to a wide array of conclusions on who should be treated and if so how. The purpose of this review is 2-fold: first, to determine the scientific validity of some of the conclusions drawn about the lack of survival impact of adjuvant pelvic RT and, second, to determine which treatment option provides the best therapeutic ratio. Overall survival may not be the ideal endpoint for early-stage endometrial cancer where death more often than not is because of causes other than endometrial cancer. Observation after hysterectomy may have the best morbidity profile, yet it may not be the option with the best therapeutic ratio. Finding a suitable alternative such as intravaginal RT or using intensity-modulated radiation therapy may ultimately prove to be the option with the best therapeutic ratio. The data learned from surgical lymph nodes staging and from the 2 recent randomized trials on the role of pelvic RT in early endometrial cancer need not be ignored nor held as the final answer. Perhaps, rectal cancer should be used as an example of how an incremental use of individual adjuvant therapies, each impacting outcome little at a time, ended up improving overall survival. If we were to use the current prevailing approach in endometrial cancer for rectal cancer, patients would still be treated with surgery alone.

Incisional skin metastasis of a squamous cell cervical carcinoma 3.5 years after radical treatment-a case report

Metastatic carcinoma in an abdominal wall incision from internal malignant neoplasm is an uncommon and often a preterminal event. Most commonly metastatic skin incisional cancers have been reported with cancers of colon, kidney, and bladder. Incisional metastasis from postoperative case of carcinoma cervix is very rare. It has been reported in few patients with adenocarcinoma and poorly differentiated histopathology, more so at drain site postoperatively. We report a postoperative case of squamous cell carcinoma cervix FIGO stage IIA in a patient who after 3.5 years of completion of radical treatment (postoperative external and intravaginal radiation therapy) developed incisional skin metastasis followed by extensive subcutaneous metastasis in the vulval region. She received salvage chemotherapy; however, she did not show any response and finally succumbed to the disease. The outcome of patients with incisional skin metastasis is usually poor as they are often associated with locoregional recurrence. The intent of treatment remains palliation either by radiation/chemotherapy/surgery alone or in combinations. As far as we know, this is the first case of squamous cell carcinoma cervix stage IIA having incisional scar recurrence 3.5 years after postoperative radiotherapy.

Is endometrial carcinoma intrinsically more aggressive in elderly patients?

The current study was conducted to determine the influence of old age (age >/= 70 years) on outcome in a group of patients with endometrial carcinoma who were treated with simple hysterectomy followed by adjuvant radiation therapy (RT). Between November 1987 and May 2000, 405 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB-II endometrial carcinoma were treated with postoperative RT. Intravaginal RT alone was given to 77% of patients (median dose, 21grays [Gy] given in 3 fractions). Additional postoperative external beam radiation therapy (EBRT) was given to 23% of patients (median dose, 45 Gy). Eighty-four patients were age >/= 70 years and 321 patients were age < 70 years. The two groups were well balanced with regard to race, comprehensive surgical staging, aggressive histology, lymphovascular invasion, lower uterine segment involvement, cervical involvement, and the use of postoperative EBRT. Significantly more patients in the age >/= 70 years group had other comorbidities such as obesity, diabetes mellitus, or hypertension (P = 0.02) and were found to have deep (> 50%) myometrial invasion (P = 0.008). With a median follow-up time of 48 months, the 5-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates were 95%, 91%, and 90% respectively. On multivariate analysis, poor LRC was found to be correlated with age >/= 70 years (P = 0.019) and lymphovascular invasion (P = 0.001). Poor DFS was found to be correlated with age >/= 70 years (P = 0.03), lymphovascular invasion (P = 0.01), and aggressive histology (P = 0.001). Similarly, poor OS was found to correlate with age >/= 70 years (P = 0.001), lymphovascular invasion (P = 0.01), aggressive histology (P = 0.01), and cervical involvement (P = 0.02). The same factors that were found to correlate with OS (age >/= 70 years, lymphovascular involvement, aggressive histology, and cervical involvement) also appeared to correlate with disease-specific survival (P = 0.03, P = 0.008, P = 0.001, and P = 0.04, respectively). The 5-year actuarial rates of Radiation Therapy Oncology Group late complications that were >/= Grade 3 (gastrointestinal tract, genitourinary tract, or vagina) were 3% in both groups. Even when treated in a similar fashion, endometrial carcinoma patients age >/= 70 years appear to fare worse than younger patients independent of other poor prognostic factors. The rate of complications from adjuvant RT, despite a higher rate of comorbidity in elderly patients, was found to be similar in both age groups. Endometrial carcinoma appears to be intrinsically more aggressive in older patients, thus mandating further improvement in their treatment strategies.

Postoperative high dose-rate intravaginal brachytherapy combined with external irradiation for early stage endometrial cancer: A long-term follow-up

Purpose: To evaluate the long-term control of disease and cure rate, complications, second malignancy, and survival of early-stage endometrial cancer patients treated with surgery, high dose-rate brachytherapy, and external beam radiation therapy. Methods and Materials: From 1969 through 1979, 300 patients with clinically staged Stage I–II endometrial cancer underwent total abdominal hysterectomy and bilateral salpingo-oopherectomy, followed by high dose-rate intravaginal radiation, 7 Gy × 3 to 0.5 cm from the mucosal surface, using a remote afterloading technique. External beam radiation therapy, 40 Gy to midplane in 4 weeks, was delivered to high risk patients through AP/PA and lateral fields. Results: The patients were followed for 5–24 years (median 12). The actuarial progression-free survival rate was 96.6%. Post-treatment grade 1–2 actuarial complication rate was 9.5%, including cystitis (4.5%), vaginal stenosis (2.5%), proctitis (1.5%), vaginal necrosis (0.5%), and partial bowel obstruction (0.5%). Neither grade 3–4 complications nor additional late complications were observed in any of our patients. Relapse rate was only 3.7%, of which 45.5% were local, 45.5% were distant, and 9% were mixed. All the patients with relapse were postmenopausal, age range of 58–77 years, with tumor grade 2–3 in 64%. Second primary cancer rate was 12.8% (mostly breast and colon). Factors that were associated with improved prognosis were young age, premenopausal, low grade, no extrauterine disease, and a histology of adenoacanthoma (adenocarcinoma with squamous metaplasia). Conclusion: High dose rate intravaginal radiation therapy combined with surgery and external beam radiation therapy achieved a high cure rate and small number of minor complications. No long-term treatment-related complications were noted in any of the patients. This treatment combination may be safely applied to patients with early stage endometrial cancer.

Postoperative vaginal radiation in endometrial cancer using a remote afterloading technique

Carcinoma of the endometrium is the most common malignancy of the female genital tract. In early stage endometrial cancer, surgery remains the primary mode of treatment while radiation therapy plays an adjuvant role. Prophylactic vaginal radiation has been shown to reduce significantly the incidence of vaginal recurrences. Between the years 1969–1976, 330 patients with FIGO Stages I and 11 endometrial cancer were treated according to a standard departmental policy in which 40 Gy of external radiation was given to high risk Stage I and all Stage II patients in combination with surgery and intravaginal radiation. Stage I was considered high risk if the tumor was of high grade or exhibited deep myometrial invasion. Vault radiation was delivered with a remote afterloading technique to a point .5 cm from the surface of the applicator; a total dose of 21 Gy was delivered in three fractions spaced two weeks apart over four elapsed weeks. With this regimen, the mucosal surface received a total equivalent dose of 40 Gy. These treatments were given on an outpatient basis without the need for any sedation or analgesics. All patients, regardless of stage, grade, or depth of myometrial invasion received adjuvant post-operative vaginal radiation. The minimum follow-up was 5 years, with a median followup of 8.5 years. The overall pelvic and/or vaginal recurrence rate was 2.7%. The incidence of vaginal complications was 3.7%. It appears that the remote afterloading treatment (RAT) for vaginal radiation is a very cost-effective therapeutic alternative, which produces minimal early or late complications and gives complete protection from radiation exposure to the medical staff. The advantages of a remote afterloading technique in delivering vaginal vault radiation in endometrial cancer are discussed in this paper.

Diagnosis and treatment of primary vaginal carcinoma in situ and dysplasia.

Fifteen cases of primary carcinoma in situ or severe or moderate dysplasia of the vagina have been diagnosed and treated during the period 1966-75 at the Department of Obstetrics and Gynecology, Turku University Central Hospital. Because of abnormal vaginal cytology the lesion was localized by means of colposcopy and iodine staining. For 6 patients local estrogen treatment was applied to increase the thickness of the epidermal layer. For 6 patients, treatment consisted of simple excision. Nine patients, including both those with carcinoma in situ, were treated with intravaginal radiation therapy. The radiation dosage was 2 000 to 2 600 rad at a distance of 1 cm from the surface of the epithelium. None of the patients showed any complications, and all are now symptom-free.

Radiotherapy for carcinoma of the cervix recurrent after surgery.

The authors evaluate radiotherapy in the treatment of carcinoma of the cervix recurrent in the pelvis after surgery. Of 38 patients, 6 are currently alive and free of disease more than 21/2 years following radiotherapy. The best results were obtained in those cases where the recurrent tumor appeared to be confined to the vagina. Whole pelvic external radiotherapy in addition to intravaginal radiation is suggested, even in those cases where tumor appears confined to the vagina.