Postoperative Vaginal Brachytherapy Research Articles

Auto‐segmentation of the clinical target volume using a domain‐adversarial neural network in patients with gynaecological cancer undergoing postoperative vaginal brachytherapy

AbstractPurposeFor postoperative vaginal brachytherapy (POVBT), the diversity of applicators complicates the creation of a generalized auto‐segmentation model, and creating models for each applicator seems difficult due to the large amount of data required. We construct an auto‐segmentation model of POVBT using small data via domain‐adversarial neural networks (DANNs).MethodsCT images were obtained postoperatively from 90 patients with gynaecological cancer who underwent vaginal brachytherapy, including 60 and 30 treated with applicators A and X, respectively. A basal model was devised using data from the patients treated with applicator A; next, a DANN model was constructed using these same 60 patients as well as 10 of those treated with applicator X through transfer learning techniques. The remaining 20 patients treated with applicator X comprised the validation set. The model's performance was assessed using objective metrics and manual clinical evaluation.ResultsThe DANN model outperformed the basal model on both objective metrics and subjective evaluation (p<0.05 for all). The median DSC and 95HD values were 0.97 and 3.68 mm in the DANN model versus 0.94 and 5.61 mm in the basal model, respectively. Multi‐centre subjective evaluation by three clinicians showed that 99%, 98%, and 81% of CT slices contoured by the DANN model were acceptable versus only 73%, 77%, and 57% of those contoured by the basal model. One clinician deemed the DANN model comparable to manual delineation.ConclusionDANNs provides a realistic approach for the wide application of automatic segmentation of POVBT and can potentially be used to construct auto‐segmentation models from small datasets.

PO-2138 Outcomes of postoperative vaginal brachytherapy in the early-stage endometrial cancer

PO-2138 Outcomes of postoperative vaginal brachytherapy in the early-stage endometrial cancer

Improving locoregional outcome in high-intermediate-risk and high-risk stage I endometrial cancer with surgical staging followed by brachytherapy.

PurposeThis study aims to assess the locoregional efficacy of postoperative vaginal brachytherapy (VBT) alone in patients undergoing surgical staging for early-stage high-intermediate-risk (HIR) and high-risk (HR) endometrial cancer. Materials and MethodsOne hundred and four patients with early-stage HIR and HR endometrial cancer who underwent surgical staging were treated with adjuvant VBT alone. The patients with stage Ib, grade I–III, stage Ia, grade III, lower uterine segment involvement, and lymphovascular invasion (LVI) were included to study. ResultsThe 5- and 10-year overall survival (OS) rates were 87% and 76%, respectively. The 5- and 10-year DFS rates were 86% and 86%, respectively. Among the patients, 92% had endometrioid adenocarcinoma, 2% had undifferentiated carcinoma, 2% had serous papillary carcinoma, and 4% had clear-cell carcinoma. Of the patients, 63% had stage Ib disease, while 37% had stage Ia disease. None of the patients had vaginal or pelvic lymph node recurrence, whereas two had para-aortic lymph node metastasis, one had surgical scar recurrence, one had para-aortic lymph node and brain metastasis, and one had lung metastasis. The presence of lymphatic invasion was found to be a statistically significant prognostic factor for increased distant metastasis rates (p = 0.020). Lymphatic invasion was also regarded as an independent prognostic factor for metastasis-free survival (p = 0.044). ConclusionOur study results suggest that postoperative VBT alone is an effective and safe treatment modality with low complication in patients undergoing surgical staging for HIR and HR endometrial cancer.

Quality of life and sexual functioning among endometrial cancer patients treated with one week adjuvant high-dose-rate vaginal brachytherapy schedule.

PurposeTo examine quality of life (QOL) and sexual functioning in a series of patients with intermediate- and high-intermediate risk endometrial cancer, treated with exclusive adjuvant one week high-dose-rate (HDR) vaginal brachytherapy (VBT) schedule.Material and methodsBetween July 2008 and October 2013, 55 patients with diagnosis of endometrial cancer were treated with adjuvant exclusive VBT. All patients had undergone surgical treatment with a laparotomy approach before VBT. Post-operative VBT was administered 6-8 weeks after surgery. Treatment was delivered to vaginal vault using Nucletron HDR unit with iridium-192 source at a dose of 21 Gy/3 fractions of 7 Gy each, three times a week, every other day, prescribed at 0.5 cm depth of vaginal wall, and 3 cm in length from the apex. QOL was assessed using European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire Core-30 (QLQ-C30), and EORTC cancer-specific quality of life questionnaire (QLQ-CX24).ResultsMedian follow-up time was 92 months (range, 42-162 months). Questionnaires were carried out respectively at 1, 3, 6, 12, 24, 36, 48, and 60 months after the end of BT. Response rate to questionnaires was 100% (n = 55). Nineteen patients (35%) answered all the questions of surveys, while 36 patients (65%) completed the surveys, except for questions on sex activity, vaginal function, and sex enjoyment. Longitudinal analysis during 5-year follow-up period showed a statistically significant trend towards worsening of fatigue, constipation, and diarrhea. Overall physical functioning and role functioning was not impaired after VBT. Over the time, sex enjoyment improved, except for elderly patients. For emotional functioning, sex worry and social functioning presented no significant time-related effect.ConclusionsOne week brachytherapy schedule to vaginal cuff is generally well-tolerated. QOL does not worsen after applying vaginal brachytherapy.

Prognosis After Pelvic Relapse for Uterine Cancer Patients Treated with Postoperative Vaginal Brachytherapy Without External Beam Radiotherapy: a Case Series

Prognosis After Pelvic Relapse for Uterine Cancer Patients Treated with Postoperative Vaginal Brachytherapy Without External Beam Radiotherapy: a Case Series

Dosimetric Comparison of 3D Treatment Planning and Conventional Planning in Post-Operative Vaginal Mold Brachytherapy (VBT) for Patients with Gynecological Malignancies

Dosimetric Comparison of 3D Treatment Planning and Conventional Planning in Post-Operative Vaginal Mold Brachytherapy (VBT) for Patients with Gynecological Malignancies

Postoperative Vaginal Brachytherapy of a Patient with Endometrial Cancer: Case Presentation

Postoperative Vaginal Brachytherapy of a Patient with Endometrial Cancer: Case Presentation

Predictors of Pelvic Recurrence in Stage IB Grade 2-3 Endometrioid Endometrial Adenocarcinoma Treated with Post-Operative Vaginal Brachytherapy

Optimal adjuvant management of surgically staged FIGO stage IB grade 2 (G2) and grade 3 (G3) endometrial endometrioid adenocarcinoma (EAC) is controversial. The objective of this study is to report outcomes utilizing adjuvant vaginal brachytherapy (VB) without pelvic radiotherapy (RT) for patients with surgically staged IB G2 and G3 EAC and to analyze rates and predictors of pelvic recurrence. Retrospective review of an institutional database identified patients diagnosed between 2005-2015 with 2009 FIGO stage IB G2 and G3 EAC. All patients underwent comprehensive surgical staging and VB as the sole adjuvant RT as per institutional guidelines during the study period. Disease free survival (DFS) was calculated from the date of primary surgery to date of last follow up or recurrence, and a minimum of 6 months follow-up was required for inclusion. Kaplan-Meier methods were used to estimate DFS. Pearson chi-squared test was used to determine association of pathologic variables and pelvic recurrence. A total of 78 patients were identified for inclusion. The median age at diagnosis was 67 (range, 42-93). Surgical staging included hysterectomy, bilateral salpingo-oopherectomy, pelvic washings, pelvic lymph node dissection (98.7%), and paraaortic node sampling (78.2%). Fifty-five patients (71%) had G2 EAC and 23 (29%) had G3 EAC. Lymphovascular invasion (LVI) was observed in 37 (47%), lower uterine segment involvement (LUSI) in 38 (49%), and outer 1/3rd myometrial invasion (MMI) (defined as ≥ 67% MMI) in 39 (50%). Median number of pelvic lymph nodes removed was 18. The majority (88.5%) received VB alone and 11.5% received VB in combination with chemotherapy. Median follow up was 45.5 months (range 6.3-151.8) and 3-year estimated DFS was 84.7% for the entire cohort. There were a total of 11 recurrences, of which 3 (27.3%) were distant only. The remainder (72.3%) had a pelvic component including 5 which were pelvic and distant and 3 which were isolated to the pelvis. Median time to recurrence was 27.8 months (range, 11.5 - 46.9). On univariate analysis, G3 versus G2 (p = 0.600), LVI present versus absent (p = 0.388), and ≥20 versus <20 pelvic nodes dissected (p = 0.051) were not associated with higher pelvic recurrence risk. Presence of LUSI (p = 0.03) and outer 1/3rd MMI (p = 0.03) were associated with increased risk of pelvic failure. Stage IB G2 and G3 patients treated with adjuvant VB following surgical staging overall fared well, and isolated pelvic recurrences were few in number. While grade and LVI were not associated with increased pelvic failure in this cohort, the association of LUSI and outer 1/3rd MMI is intriguing. Further investigation into risk factors for pelvic recurrence in stage I EAC would be valuable to identify subgroups which benefit the most from pelvic RT.

Dilator Use After Vaginal Brachytherapy for Endometrial Cancer: A Randomized Feasibility and Adherence Study.

Vaginal brachytherapy, a common treatment of endometrial cancer, is associated with high rates of vaginal stenosis. Recommendations for vaginal dilator use to minimize stenosis generally include 3 times per week for approximately 10 minutes per use. However, adherence rates range widely and are generally well less than 50%. The aims of this study were to assess feasibility of recruitment to a study of dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence. Eligibility included women treated with postoperative vaginal brachytherapy for stage I to IIIc endometrial cancer. Patients were randomized to either nurse-delivered standard institutional instruction or EEP. Of eligible patients, 76% consented, 42 were randomized, and 69% completed the 6-month assessment. Mean age was 58.2 years; 48% were sexually active. There was no difference in adherence between arms. Overall, 20% and 8.3% were adherent to the prescribed use of 3 times per week, and 64% and 16% were adherent to use at least once per week at 6 weeks and 6 months, respectively. Adherence was greater among those motivated by vaginal health and having lower body mass index. Nonadherence was significantly higher among those who are college educated, in the EEP group, and with higher weight. Feasibility of recruitment into a study of vaginal dilator use was high. Adherence was low, and there was no difference between groups. Adherence to vaginal dilator use requires novel interventions to test. Nursing education that includes how dilators may maintain vaginal health may improve use because it was a motivator for adherence in this study.

Comparison of different treatment planning optimization methods for vaginal HDR brachytherapy with multichannel applicators: A reduction of the high doses to the vaginal mucosa is possible

PurposeA direct planning approach with multi-channel vaginal cylinders (MVCs) used for HDR brachytherapy of vaginal cancers is particularly challenging. Purpose of this study was to compare the dosimetric performances of different forward and inverse methods used for the optimization of MVC-based vaginal treatments for endometrial cancer, with a particular attention to the definition of strategies useful to limit the high doses to the vaginal mucosa. MethodsTwelve postoperative vaginal HDR brachytherapy treatments performed with MVCs were considered. Plans were retrospectively optimized with three different methods: Dose Point Optimization followed by Graphical Optimization (DPO + GrO), Inverse Planning Simulated Annealing with two different class solutions as starting conditions (surflPSA and homogIPSA) and Hybrid Inverse Planning Optimization (HIPO). Several dosimetric parameters related to target coverage, hot spot extensions and sparing of organs at risk were analyzed to evaluate the quality of the achieved treatment plans. Dose homogeneity index (DHI), conformal index (COIN) and a further parameter quantifying the proportion of the central catheter loading with respect to the overall loading (i.e., the central catheter loading index: CCLI) were also quantified. ResultsThe achieved PTV coverage parameters were highly correlated with each other but uncorrelated with the hot spot quantifiers. HomogIPSA and HIPO achieved higher DHIs and CCLIs and lower volumes of high doses than DPO + GrO and surflPSA. ConclusionsWithin the investigated optimization methods, HIPO and homoglPSA showed the highest dose homogeneity to the target. In particular, homogIPSA resulted also the most effective in reducing hot spots to the vaginal mucosa.

OC-0368: Postoperative vaginal brachytherapy: a quality assurance dummy-run procedure in the PORTEC-4 trial

OC-0368: Postoperative vaginal brachytherapy: a quality assurance dummy-run procedure in the PORTEC-4 trial

2733 Postoperative External Beam Radiotherapy versus Vaginal Brachytherapy alone in patients with early stages of uterine carcinoma - our experience

2733 Postoperative External Beam Radiotherapy versus Vaginal Brachytherapy alone in patients with early stages of uterine carcinoma - our experience

Adjuvant radiotherapy in Stage II endometrial carcinoma: Is brachytherapy alone sufficient for local control?

To evaluate recurrence patterns and overall survival in patients treated with adjuvant radiation after surgical staging for Stage II endometrial carcinoma. Secondary goals include identification of prognostic factors for recurrence and toxicity assessment. The medical records of 41 patients treated with adjuvant radiotherapy at Washington University School of Medicine after surgical staging for endometrial cancer (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, lymph node dissection) were reviewed. Nineteen were treated with a combination of external beam radiotherapy and vaginal brachytherapy (VB), and 22 patients were treated with postoperative VB alone. Median followup for all patients was 41 months. Median patient age was 59 years (range, 42-87 years). All tumors were of endometrioid histology. There were 20 Grade 1 tumors, 13 Grade 2 tumors, and 8 Grade 3 tumors. For all patients, the 5-year overall survival was 69.8%, and the 5-year recurrence-free survival was 89.0%. There was no statistically significant difference in overall survival (p = 0.510) or freedom from vaginal (p = 0.840), distant (p = 0.133), or any recurrence (p = 0.275) with respect to modality of treatment (external beam radiotherapy and VB vs. VB alone). There were no pelvic lymph node recurrences. In the univariate analysis, there were no risk factors influencing overall survival or recurrences. One patient experienced a toxicity requiring hospital admission. She was treated with pelvic external beam radiation plus brachytherapy. VB alone results in excellent local control for patients with Stage II endometrial cancer after surgical staging. Long-term toxicities are rare and more common in the group of patients who were treated with pelvic external beam plus brachytherapy.

Comparison of Target Volume and Organ at Risk Doses With Multi-channel Versus Single Channel Cylinder for Vaginal Brachytherapy

Purpose/Objective(s)Postoperative vaginal brachytherapy is used in intermediate and high risk endometrial cancer patients either alone or after pelvic irradiation. We aimed to assess the dosimetric parameters of a multi-channel vaginal cylinder applicator compared to traditional single channel cylinder for vaginal brachytherapy.Materials/MethodsTen patients were treated with multi-channel cylinder using the 6 peripheral channels. Single channel plans were generated for comparison. CTV was defined as 5 mm lateral and 3 mm AP volumetric expansion of the cylinder. The prescription dose was 5.5 Gy to CTV for each of 5 fractions. Plans were optimized to achieve D90>100% for CTV. Both plans were compared for D5cc, D2cc, D1cc and D0.1 cc of rectum and the bladder.ResultsThe vaginal cylinder diameters ranged from 3 to 3.5 cm, and the active source lengths ranged from 3 to 4 cm. Mean CTV D90 values were 104% for single channel and 105% (p = 0.53) for multichannel plans. The rectal D5cc, D2cc, D1cc and D 0.1cc doses were reduced by 7.2% (p<0.001), 6.2% (p = 0.001), 7.3% (p = 0.003) and 3.3% (p = 0.233), respectively in multi-channel plans compared to single channel plans. Similarly, the bladder doses were reduced by 11.4% (p = 0.001), 12.4% (p = 0.004), 13.8% (p = 0.031) and 20.5% (p = 0.153), respectively.ConclusionsVaginal brachytherapy with multi-channel cylinder is able to provide similar target volume coverage and a better organ at risk sparing in asymmetrical CTVs. Purpose/Objective(s)Postoperative vaginal brachytherapy is used in intermediate and high risk endometrial cancer patients either alone or after pelvic irradiation. We aimed to assess the dosimetric parameters of a multi-channel vaginal cylinder applicator compared to traditional single channel cylinder for vaginal brachytherapy. Postoperative vaginal brachytherapy is used in intermediate and high risk endometrial cancer patients either alone or after pelvic irradiation. We aimed to assess the dosimetric parameters of a multi-channel vaginal cylinder applicator compared to traditional single channel cylinder for vaginal brachytherapy. Materials/MethodsTen patients were treated with multi-channel cylinder using the 6 peripheral channels. Single channel plans were generated for comparison. CTV was defined as 5 mm lateral and 3 mm AP volumetric expansion of the cylinder. The prescription dose was 5.5 Gy to CTV for each of 5 fractions. Plans were optimized to achieve D90>100% for CTV. Both plans were compared for D5cc, D2cc, D1cc and D0.1 cc of rectum and the bladder. Ten patients were treated with multi-channel cylinder using the 6 peripheral channels. Single channel plans were generated for comparison. CTV was defined as 5 mm lateral and 3 mm AP volumetric expansion of the cylinder. The prescription dose was 5.5 Gy to CTV for each of 5 fractions. Plans were optimized to achieve D90>100% for CTV. Both plans were compared for D5cc, D2cc, D1cc and D0.1 cc of rectum and the bladder. ResultsThe vaginal cylinder diameters ranged from 3 to 3.5 cm, and the active source lengths ranged from 3 to 4 cm. Mean CTV D90 values were 104% for single channel and 105% (p = 0.53) for multichannel plans. The rectal D5cc, D2cc, D1cc and D 0.1cc doses were reduced by 7.2% (p<0.001), 6.2% (p = 0.001), 7.3% (p = 0.003) and 3.3% (p = 0.233), respectively in multi-channel plans compared to single channel plans. Similarly, the bladder doses were reduced by 11.4% (p = 0.001), 12.4% (p = 0.004), 13.8% (p = 0.031) and 20.5% (p = 0.153), respectively. The vaginal cylinder diameters ranged from 3 to 3.5 cm, and the active source lengths ranged from 3 to 4 cm. Mean CTV D90 values were 104% for single channel and 105% (p = 0.53) for multichannel plans. The rectal D5cc, D2cc, D1cc and D 0.1cc doses were reduced by 7.2% (p<0.001), 6.2% (p = 0.001), 7.3% (p = 0.003) and 3.3% (p = 0.233), respectively in multi-channel plans compared to single channel plans. Similarly, the bladder doses were reduced by 11.4% (p = 0.001), 12.4% (p = 0.004), 13.8% (p = 0.031) and 20.5% (p = 0.153), respectively. ConclusionsVaginal brachytherapy with multi-channel cylinder is able to provide similar target volume coverage and a better organ at risk sparing in asymmetrical CTVs. Vaginal brachytherapy with multi-channel cylinder is able to provide similar target volume coverage and a better organ at risk sparing in asymmetrical CTVs.

Electronic brachytherapy for postsurgical adjuvant vaginal cuff irradiation therapy in endometrial and cervical cancer: A retrospective study

A new platform for brachytherapy called electronic brachytherapy (EBT) has been developed, which uses a miniature X-ray source to generate low-energy radiation. A retrospective study of adverse events and clinical outcomes in patients treated with EBT to the vaginal cuff, eitheras monotherapy or in combination with external beam radiation therapy (EBRT), was conducted. Medical records were reviewed from 16 patients treated with postoperative EBT for endometrial (n=13) or cervical cancer (n=3) between February 2009 and November 2010. Patients received either intracavitary vaginal EBT alone or EBT in combination with EBRT. The radiobiologic effectiveness of EBT was assumed to be one. Median follow-up was 20.5 months (range, 7-36 months). When EBT was used alone (n=5), the median dose per fraction, number of fractions, and total dose delivered were: 6Gy (range, 5.5-6.2Gy), 5 fractions (range, 5-6), and 30Gy (range, 30-34Gy), respectively. When EBT was combined with EBRT, the EBT component median dose per fraction, number of fractions, and total dose delivered were: 5Gy (range, 4.5-7Gy), 2 fractions (range, 2-4), and 14Gy (range, 9-20Gy), respectively. The median EBRT dose was 45Gy (range, 45-49.2Gy). Our local control rate, locoregional (pelvic) control rate, and overall survival rate were 94%, 94%, and 88%, respectively. Of the 16 patients, 4 patients reported Grade 2 or greater toxicity (25%); however, there were no Grade 4-5 adverse events. Gynecologic, genitourinary, and gastrointestinal adverse events accounted for 57% (n=4), 43% (n=3), and 0% (n=0) of all Grade 2 or greater side effects. No Grade 2 or higher toxicities were noted in patients treated with EBT alone. EBT is an acceptable means of delivering postoperative vaginal brachytherapy and appears comparable with other methods; as the sole method of treatment, the toxicity rates of EBT are low.

Completed versus aborted radical hysterectomy for node-positive stage IB cervical cancer in the modern era of chemoradiation therapy

ObjectiveDebate continues about optimal management of patients with node-positive stage I cervical cancer. Our objective was to determine if patient outcomes are affected by radical hysterectomy in the modern era of adjuvant chemoradiation. MethodsCervical cancer patients diagnosed from 2000 to 2008 were identified. Demographics, therapy, clinicopathologic data, progression free survival (PFS), overall survival (OS), total radiation exposure, and grade 3–4 complications were analyzed by student t, Mann–Whitney, Fisher's exact, Kaplan–Meier, and log rank tests. ResultsThis single-institution review evaluated forty-one of 334 (13.4%) patients scheduled to undergo radical hysterectomy that had gross nodal disease diagnosed intraoperatively. 15 underwent aborted radical hysterectomy following lymphadenectomy; the remaining 26 underwent radical hysterectomy and lymphadenectomy. Eleven patients undergoing radical hysterectomy underwent whole pelvic radiation therapy (WPRT) while 8 (30.7%) patients underwent WPRT and postoperative vaginal brachytherapy (BT) for local treatment secondary to close margins. All patients undergoing aborted radical hysterectomy underwent WPRT and BT. With mean follow-up of 42.3months, there were no significant differences in urinary, gastrointestinal, or hematologic complications between groups. When comparing those undergoing radical hysterectomy to aborted radical hysterectomy, there were no significant differences in local recurrence (11.5% vs 26.7%, p=0.39) or distant recurrence (19.2% vs. 33.3%, p=0.45), PFS (74.9months vs 46.8months, p=0.106), or OS (91.8months vs 69.4months, p=0.886). ConclusionsTreatment of patients with early stage cervical cancer and nodal metastasis may be tailored intraoperatively. Completion of radical hysterectomy and lymphadenectomy decreases radiation exposure without apparently compromising safety or outcome in the era of adjuvant chemoradiation.

Clinical Outcomes in International Federation of Gynecology and Obstetrics Stage IA Endometrial Cancer With Myometrial Invasion Treated With or Without Postoperative Vaginal Brachytherapy

To assess the clinical outcomes of patients with Stage IA endometrial cancer with myometrial invasion treated with postoperative vaginal brachytherapy (VBT) with those who received no adjuvant therapy (NAT). All patients treated with hysterectomy for endometrial cancer at Northwestern Memorial Hospital between 1978 and 2005 were identified. Those patients with Stage IA disease with myometrial invasion who were treated with VBT alone or NAT were identified and included in the present analysis. Of 252 patients with Stage IA endometrial cancer with superficial (<50%) myometrial invasion who met the inclusion criteria, 169 underwent VBT and 83 received NAT. The median follow-up in the VBT and NAT groups was 103 and 61 months, respectively. In the VBT group, 56.8% had Grade 1, 37.9% had Grade 2, and 5.3% had Grade 3 tumors. In the NAT group, 75.9%, 20.5%, and 3.6% had Grade 1, 2, and 3 tumors, respectively. Lymphatic or vascular space invasion was noted in 12.4% of the VBT patients and 5.6% of the NAT patients. The 5-year overall survival rate was 95.5%. The 5-year recurrence-free survival rate was 92.4% for all patients, 94.4% for the VBT group, and 87.4% for the NAT group (p = NS). Of the 169 VBT patients and 83 NAT patients, 8 (4.7%) and 6 (7.2%) developed recurrent disease. One vaginal recurrence occurred in the VBT group (0.6%) and three in the NAT group (3.8%). Recurrences developed 2-102 months after surgical treatment. Two of the four vaginal recurrences were salvaged. No Grade 3 or higher acute or late radiation toxicity was noted. The use of postoperative VBT in patients with Stage I endometrial cancer with <50% myometrial invasion yielded excellent vaginal disease control and disease-free survival, with minimal toxicity.

Comparison of 2D and 3D Imaging and Treatment Planning for Postoperative Vaginal Apex High-Dose Rate Brachytherapy for Endometrial Cancer

To evaluate bladder and rectal doses using two-dimensional (2D) and 3D treatment planning for vaginal cuff high-dose rate (HDR) in endometrial cancer. Ninety-one consecutive patients treated between 2000 and 2007 were evaluated. Seventy-one and 20 patients underwent 2D and 3D planning, respectively. Each patient received six fractions prescribed at 0.5 cm to the superior 3 cm of the vagina. International Commission on Radiation Units and Measurements (ICRU) doses were calculated for 2D patients. Maximum and 2-cc doses were calculated for 3D patients. Organ doses were normalized to prescription dose. Bladder maximum doses were 178% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were no different than ICRU doses (p = 0.22). Two-cubic centimeter doses were 59% of maximum doses (p < 0.0001). Rectal maximum doses were 137% of ICRU doses (p<0.0001). Two-cubic centimeter doses were 87% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were 64% of maximum doses (p < 0.0001). Using the first 1, 2, 3, 4 or 5 fractions, we predicted the final bladder dose to within 10% for 44%, 59%, 83%, 82%, and 89% of patients by using the ICRU dose, and for 45%, 55%, 80%, 85%, and 85% of patients by using the maximum dose, and for 37%, 68%, 79%, 79%, and 84% of patients by using the 2-cc dose. Using the first 1, 2, 3, 4 or 5 fractions, we predicted the final rectal dose to within 10% for 100%, 100%, 100%, 100%, and 100% of patients by using the ICRU dose, and for 60%, 65%, 70%, 75%, and 75% of patients by using the maximum dose, and for 68%, 95%, 84%, 84%, and 84% of patients by using the 2-cc dose. Doses to organs at risk vary depending on the calculation method. In some cases, final dose accuracy appears to plateau after the third fraction, indicating that simulation and planning may not be necessary in all fractions. A clinically relevant level of accuracy should be determined and further research conducted to address this issue.

Quality of life and sexual functioning in endometrial cancer survivors

ObjectiveRecent evidence suggests equivalent efficacy in terms of local control for adjuvant vaginal brachytherapy (VBT) compared to external beam radiotherapy after surgery in patients with intermediate-high endometrial cancer. The objective of this study is to compare the quality of life (QoL) and sexual function of women with endometrial cancer that were treated with either surgery alone or surgery in combination with postoperative VBT. MethodsWomen were interviewed at least 5years after initial treatment for endometrial cancer. QoL was evaluated by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and the cervical cancer module, CX-24. Sexual function was evaluated by using the Female Sexual Function Index (FSFI). Eligible women had early stage disease, were currently disease-free, and had undergone surgery and adjuvant VBT, but neither external beam radiotherapy nor systemic treatment. This study group were then compared using univariate and multivariate analyses with an age-matched control group comprising of endometrial cancer patients without adjuvant VBT. ResultsFifty-five patients (29 surgery plus VBT and 26 surgical controls without VBT) were included for analysis. With respect to QoL including, e.g., physical, role, emotional and social functioning and likewise in terms of sexual function univariate and multivariate analyses did not show significant differences between patients with VBT and the controls without VBT of any of the outcome measures. ConclusionAdjuvant VBT after surgery does not seem to have a significant impact on quality of life and sexual function in endometrial cancer survivors.

Ultrasound-based Determination of Vaginal Wall Thickness in Postoperative Vaginal Brachytherapy for Endometrial Cancer

Ultrasound-based Determination of Vaginal Wall Thickness in Postoperative Vaginal Brachytherapy for Endometrial Cancer