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External-beam radiotherapy and/or HDR brachytherapy in postoperative endometrial cancer patients: clinical outcomes and toxicity rates

Brachiterapia HDR associata o meno alla radioterapia a fasci esterni in pazienti operate per carcinoma endometriale: risultati clinici e tossicità

  • Radiotherapy / Radioterapia
  • Published:
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Abstract

Purpose

The objectives of this study were to evaluate local disease control, overall survival (OS), disease-free survival (DFS) and local relapse-free survival (LRFS) in patients with endometrial cancer undergoing adjuvant vaginal brachytherapy (VBT)±external-beam radiotherapy (EBRT).

Materials and methods

From September 2007 to February 2011, 40 patients with endometrial cancer were retrospectively analysed. Surgery consisted of total hysterectomy and bilateral salpingo-oophorectomy without node dissection (16 patients) or with bilateral pelvic node dissection (24 patients). The stage distribution was as follows: two IA, nine IB, 12 IC, five IIA, eight IIB, two IIIA and two IIIC. Thirty-four patients underwent EBRT and VBT. Six patients received VBT alone.

Results

Median follow-up was 26 months. The 5-year OS and DFS were 96.4% and 86.9%, respectively. No local recurrence was observed. Four patients presented distant disease (three had lung metastases and one had hepatic node metastases). Acute EBRT-related toxicities were seen in 15 (38%) patients. We recorded late toxicities in 14 patients (35%). There was no evidence of grade 3–4 toxicity.

Conclusions

Adjuvant EBRT and/or VBT in patients with endometrial cancer showed good outcomes in terms of local disease control, with an acceptable toxicity profile.

Riassunto

Obiettivo

L’obiettivo dello studio è stato di valutare il controllo locale, la sopravvivenza globale (OS), la sopravvivenza libera da malattia (DFS) e la sopravvivenza libera da recidiva locale in pazienti con cancro dell’endometrio sottoposti a brachiterapia (BRT)±radioterapia (RT) a fasci esterni adiuvante.

Materiali e metodi

Da settembre 2007 a febbraio 2011, quaranta pazienti con tumore dell’endometrio sono state analizzate. La chirurgia consisteva nell’isterectomia totale e annessiectomia bilaterale senza linfadenectomia (16 pazienti), o con linfadenectomia pelvica (24 pazienti). Lo stadio patologico era: 2 IA, 9 IB, 12 IC, 5 IIA, 8 IIB, 2 IIIA e 2 IIIC. Trentaquattro pazienti avevano ricevuto RT pelvica e BRT. Sei pazienti avevano ricevuto solo brachiterapia.

Risultati

Il follow-up mediano è stato di 26 mesi. L’OS e la DFS a 5 anni sono state 96,4% e 86,9%, rispettivamente. Nessuna paziente presentava recidiva locale. Quattro pazienti manifestavano metastasi a distanza: (3 pazienti: malattia polmonare; 1 paziente: linfonodi epatici metastatici). Gli effetti tossici acuti sono stati osservati nel 38% dei pazienti e quelli tardivi nel 35%. Nessuna tossicità di 3–4 grado è stata rilevata.

Conclusioni

La RT pelvica e/o BRT adiuvante hanno mostrato un buon controllo locale di malattia con tossicità accettabile nei pazienti con cancro dell’endometrio.

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References/Bibliografia

  1. Parkin DM, Bray F, Farley J, Pisani P (2005) Global Cancer Statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  2. Creasman WT, Odicino F, Maisonneuve P et al (2006) Carcinoma of the corpus uteri. FIGO 60th annual report on the results of treatment in gynecological cancer. Int J Gyneacol Obstet 95(Suppl 1):S105–S143

    Article  Google Scholar 

  3. ACOG Committee on Practice Bulletins. American College of Obstetricians and Gynecologist (2005) ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologist, n. 65 August 2005: management of endometrial cancer. Obstet Gynecol 106:413–425

    Article  Google Scholar 

  4. Miller DA, Richardson S, Grigsby PW (2010) A new method of anatomically conformal vaginal cuff HDR brachytherapy. Gynecol Oncol 116:413–418

    Article  PubMed  Google Scholar 

  5. Alektiar KM, McKee A, Venkatraman E et al (2002) Intravaginal high-doserate brachytherapy for stage IB (FIGO Grade 1, 2) endometrial cancer. Int J Radiat Oncol Biol Phys 53:707–713

    Article  PubMed  Google Scholar 

  6. Rittenberg PV, Lotocki RJ, Heywood MS et al (2003) High-risk surgical stage 1 endometrial cancer: outcomes with vault brachytherapy alone. Gynecol Oncol 89:288–294

    Article  PubMed  Google Scholar 

  7. Jolly S, Vargas C, Kumar T et al (2005) Vaginal brachytherapy alone: An alternative to adjuvant whole pelvis radiation for early stage endometrial cancer. Gynecol Oncol 97:887–892

    Article  PubMed  Google Scholar 

  8. Gadducci A, Greco C (2010) The evolving role of adjuvant therapy in endometrial cancer. Crit Rev Oncol Hematol 78:79–91

    Article  PubMed  Google Scholar 

  9. Nout RA, Smit VT, Putter H et al (2010) Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 375:816–823

    Article  PubMed  CAS  Google Scholar 

  10. Nout RA, Putter H, Jürgenliemk-Schulz IM et al (2009) Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol 27:3547–3556

    Article  PubMed  Google Scholar 

  11. Kitchener H, Powell M (2010) Radiotherapy for endometrial cancer: a key in the jigsaw. Lancet 375:781–782

    Article  PubMed  Google Scholar 

  12. Cox JD, Stetz J, Pajak TF et al (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346

    Article  PubMed  CAS  Google Scholar 

  13. LENT-Soma tables (1995) Radiother Oncol 35:17–60

    Article  Google Scholar 

  14. Crosby MA, Tward JD, Szabo A et al (2010) Does brachytherapy improve survival in addition to external beam radiation therapy in patients with high risk stage I and II endometrial carcinoma. American J of Clin Oncol 33:364–369

    Article  Google Scholar 

  15. Scholtem AN, van Putten WL, Beerman H et al; PORTEC Study Group (2005) Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys 6:834–838

    Article  Google Scholar 

  16. Aalders J, Abeler V, Kolstad P, Onsrud M (1980) Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol 56:419–427

    PubMed  CAS  Google Scholar 

  17. Keys HM, Roberts JA, Brunetto VL et al; Gynecologic Oncology Group (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 92:744–751

    Article  PubMed  Google Scholar 

  18. Creutzberg CL (2004) GOG-99: ending the controversy regarding pelvic radiotherapy for endometrial carcinoma? Gynecol Oncol 92:740–743

    Article  PubMed  Google Scholar 

  19. Viani GA, Patia BF, Pellizzon AC et al (2006) High-risk surgical stage I endometrial cancer: analysis of treatment out come. Radiat Oncol 1:24

    Article  PubMed  Google Scholar 

  20. Kitchener H, Swart AM, Qian Q et al; ASTEC study group (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  PubMed  CAS  Google Scholar 

  21. Blake P, Swart AM, Orton J et al ASTEC Study Group (2009) Adjuvant external beam radiotherapy in the treatment of endometrial cancer: pooled trial results, systematic review, and metastatic-analysis. Lancet 373:37–46

    Google Scholar 

  22. Mariani A, Dowdy SC, Cliby WA et al (2006) Efficacy of systematic lymphadenctomy and adjuvant radiotherapy in node-positive endometrial cancer patients. Gynecol Oncol 101:200–208

    Article  PubMed  Google Scholar 

  23. Benedetti Panici P, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Nalt Cancer Inst 100:1707–1716

    Article  Google Scholar 

  24. Rossi PJ, Jani AB, Horowitz IR, Johnstone PA (2008) Adjuvant brachytherapy removes survival disadvantage of local disease extension in stage IIIC endometrial cancer: a seer registry analysis. Int J rad Oncol Biol Phys 70:134–138

    Article  Google Scholar 

  25. Korcum AF, Duman E, Aksu G (2010) The results of adjuvant radiotherapy in endometrial carcinoma. Gynecol Endocrinol 26:240–245

    Article  PubMed  Google Scholar 

  26. Cannon GM, Geye H, Terakedis BE et al (2009) Outcomes following surgery and adjuvant radiation in stage II endometrial adenocarcinoma. Gynec Oncol 113:176–180

    Article  CAS  Google Scholar 

  27. Lin LL, Mutch DG, Rader JS et al (2007) External radiotherapy versus vaginal brachytherapy for patients with intermediate risk endometrial cancer. Gynec Oncol 106:215–220

    Article  Google Scholar 

  28. Bolukbasi Y, Demirci S, Ozsaran Z et al (2008) Postoperative radiotherapy in intermediate and high-risk stage I endometrial cancer: analysis of prognostic factors and survival. Eur J Gynaecol Oncol 29:505–510

    PubMed  CAS  Google Scholar 

  29. Maggi R, Lissoni A, Spina F et al (2006) Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomized trial. Br J Cancer 95:266–271

    Article  PubMed  CAS  Google Scholar 

  30. Huscher A, Bignardi M, Magri E et al (2009) Determinanats of small bowel toxicity in postoperative pelvic irradiation for gynaecological malignancies. Anticancer Res 9:4821–4826

    Google Scholar 

  31. Rovirosa A, Ascaso C, Sanchez-Reyes A et al (2010) Three or four fractions of 4–5 Gy per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. Int J Radiat Oncol Biol Phys 81:418–423

    Article  PubMed  Google Scholar 

  32. Klopp AH, Jhingran A, Ramondetta L et al (2009) Node-positive adenocarcinoma of the endometrium: outcome and patterns of recurrence with or without external beam irradiation. Gynecol Oncol 115:6–11

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Radiation Oncology, University “La Sapienza”, Ospedale S. Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy

    V. De Sanctis, L. Agolli, M. Valeriani, M. F. Osti & R. Maurizi Enrici

  2. Division of Medical Physics, University “La Sapienza”, Rome, Italy

    S. Narici

  3. Department of Health Science, University of L’Aquila, L’Aquila, Italy

    F. Patacchiola

  4. Department of Women Health and Medicine of the Territory, University “La Sapienza”, Rome, Italy

    B. Mossa & M. Moscarini

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  1. V. De Sanctis
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  2. L. Agolli
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  3. M. Valeriani
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  4. S. Narici
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  5. M. F. Osti
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  7. B. Mossa
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  9. R. Maurizi Enrici
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Correspondence to L. Agolli.

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De Sanctis, V., Agolli, L., Valeriani, M. et al. External-beam radiotherapy and/or HDR brachytherapy in postoperative endometrial cancer patients: clinical outcomes and toxicity rates. Radiol med 118, 311–322 (2013). https://doi.org/10.1007/s11547-012-0833-7

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  • DOI: https://doi.org/10.1007/s11547-012-0833-7

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