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Is one brachytherapy fraction of 7 Gy similar to more fractions after external beam irradiation in postoperative endometrial carcinoma?

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Abstract

Purpose

To determine whether brachytherapy with a single hypofractionated dose of 7 Gy provides the similar vaginal-cuff relapses and safety profile in terms of complications compared to schedules of 2 or 3 fractions of lower doses in patients treated previously with external beam irradiation in postoperative endometrial carcinoma.

Methods/material

From June 2003 to December 2016, 325 patients were treated with 3 different schedules of high-dose-rate brachytherapy after external beam irradiation for postoperative endometrial carcinoma. The patients were divided into 3 groups: Group-1: 125 patients were treated with 3 fractions of 4–6 Gy per fraction (3 fractions/week) between 2003 and 2008; Group-2: 93 patients were treated with 2 consecutive daily fractions of 5–6 Gy between 2008 and 2011; Group-3: 107 patients received a single fraction of 7 Gy between 2011 and 2016. Bladder and rectum complications were assessed using RTOG scores and with the objective scores of LENT-SOMA for the vagina. Statistics: the chi-square test.

Results

The mean follow-up of Groups 1, 2 and 3 was 95, 67 and 51 months, respectively. Three patients in Group-1, 2 in Group-2, 1 in Group-3 developed vaginal-cuff relapse (p = 0.68). No differences were found in late toxicity among the three groups.

Conclusions

One single dose of 7 Gy is safe and effective and may be the best treatment schedule with a similar incidence of vaginal-cuff relapses, complications and patient comfort with less hospital attendance.

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Acknowledgements

Grant Spanish Association Against Cancer Foundation (AECC) (PS141526ROVI).

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Authors and Affiliations

  1. Radiation Oncology Department, Hospital Clinic I Universitari, C/ Villarroel 170, 08036, Barcelona, Spain

    Y. Zhang, A. Herreros, Y. Li, A. Biete & Á. Rovirosa

  2. Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain

    Y. Zhang, C. Ascaso, A. Herreros, Y. Li, A. Biete & Á. Rovirosa

  3. Economics Department, Hospital Clinic I Universitari, Barcelona, Spain

    J. Sánchez

  4. Gynecological Cancer Unit, Gynecological and Obstetrics Department, Hospital Clinic I Universitari, Barcelona, Spain

    M. del Pino, A. Torné & Á. Rovirosa

  5. Radiation Oncology Department, Hospital General Universitario de Albacete, Albacete, Spain

    S. Sabater

  6. Radiation Oncology Department, Hospital San Joan de Reus, Reus, Spain

    M. Arenas

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  1. Y. Zhang
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Contributions

YZ, CA, AR: Conceptualization; YZ, CA, AR: Methodology; YZ, CA, AR: Formal analysis and investigation; YZ: Writing—original draft preparation; AR, CA: Writing—review and editing; CA, AH, JS, AT, YL, SS, MP, MA, AB, ÁR: Supervision.

Corresponding author

Correspondence to Á. Rovirosa.

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The authors declare that they have no conflict of interest.

Ethical approval

All the research has been approved by the ethics committee at the Hospital Clinic I Universitari and have, therefore, been performed in accordance with the ethical standards.

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All the patients gave their informed consent prior to their inclusion in the study.

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Zhang, Y., Ascaso, C., Herreros, A. et al. Is one brachytherapy fraction of 7 Gy similar to more fractions after external beam irradiation in postoperative endometrial carcinoma?. Clin Transl Oncol 22, 1295–1302 (2020). https://doi.org/10.1007/s12094-019-02255-z

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  • DOI: https://doi.org/10.1007/s12094-019-02255-z

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