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Exclusive 3D-brachytherapy as a good option for stage-I inoperable endometrial cancer: a retrospective analysis in the gynaecological cancer GEC-ESTRO Working Group

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Abstract

Purpose

Analyse outcomes of stage-I inoperable endometrial cancer (EC) patients from seven European centres treated with 3D-image-guided brachytherapy (IGBT) alone.

Materials and methods

From 2004 to 2018, 62 patients (41 stage-IA and 21 IB) were retrospectively studied, analysing anaesthetic procedure, applicator type, BT-planning imaging, clinical target volume (CTV), BT schedule, overall daily-dose equivalent to 2 Gy (EQD2(α/β=4.5 or 3)) to the CTV(α/β=4.5) and D2 cm3(α/β=3) for organs at risk. Complications were evaluated using CTCAEv4 scores. The 2 and 5 year survival was calculated [cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS)]. Descriptive analysis and the Kaplan–Meier method were used for survival analysis.

Results

Mean follow-up: 32.8 months (SD 33.7). Spinal anaesthesia (38/62) followed by none (16/62) were the most common. Y-shaped Rotte applicators were used in 74% of patients. High-dose rate brachytherapy was administered in 89%. Median D90 to the CTV was 58.9 Gy (8.66–144 Gy). Eight patients presented relapse: four uterine, four nodal and four distant. The 2 and 5 year CSS was 93.3 and 80.5%, DFS 84.8 and 80.5%, LRFS was 93.1 and 88.7%, LRRFS was 91 and 91% and DMFS was 90.2 and 90.2%, respectively, CSS was better in stage-IA vs. IB (p = 0.043). Late vaginal and bladder G3-complication rates were 2.1%, respectively.

Conclusion

Inoperable EC patients can be safely treated by BT with 2 and 5 year CSS of 93 and 80.5%, respectively, with even better results for IA cases. Prospective studies on 3D-IGBT are necessary to better analyse EC patient outcomes based on dose and treated volumes.

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Acknowledgments

Prof. Carlos Ascaso for his statistical support.

Author information

Authors and Affiliations

  1. Fonaments Clinics Department, Faculty of Medicine, Universitat de Barcelona, C/Casanovas 153, 08036, Barcelona, Spain

    Angeles Rovirosa

  2. Cancer Center, Henan Provincial People’s Hospital, Zhengzhou, China

    Yaowen Zhang

  3. Radiation Oncology Department, Institute Gustave Roussy, 114, rue Édouard-Vaillant, 94805, Villejuif Cedex, France

    Cyrus Chargari

  4. Leeds Cancer Centre, Beckett Street, Leeds, LS9 7TF, UK

    Rachel Cooper & Peter Bownes

  5. Maria Sklodowska-Curie National Research Institute of Oncology, Oddział w Gliwicach Ul Wybrzeże Armii Krajowej, 15 44-102, Gliwice, Poland

    Piotr Wojcieszek & Magdalena Stankiewicz

  6. Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK

    Peter Hoskin

  7. Radiotherapie Groep/Arnhem, Radiation Oncology Department, Wagnerlaan 47, 6815 AD, Arnhem, The Netherlands

    Elzbieta Van der Steen-Banasik

  8. Institute of Oncology of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia

    Barbara Segedin

  9. Institut Català D’Oncologia, Avinguda Granvia de l’Hospitalet 199-203, 08908, l’, Hospitalet de Llobregat, Barcelona, Spain

    Dina Najjari

  10. Department of Radiation Oncology, Medical University of Vienna, Spitalgasse, 23 1090, Vienna, Austria

    Richard Pötter

  11. Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark

    Kari Tanderup

  12. Radiation Oncology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium

    Erik Van Limbergen

Authors
  1. Angeles Rovirosa
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Consortia

Endometrial Task Group in the Gynecological Cancer Working Group

GEC-ESTRO Working Group

Contributions

Conceptualization: A.R and E.V.L. Investigation: A.R., Y.Z. and C.Ch. Formal analysis: Y.Z. and A.R. Data curation Y.Z. and A.R. Writing—original draft preparation: A.R., C.Ch., K.T, and E.V.L. Supervision: A.R. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Angeles Rovirosa.

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Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethical approval

The local Ethics committee of Hospital Clinic of Barcelona approved this study (HCB/2018/0341).

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All patients signed an informed consent form that included consent for publication.

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All patients signed an informed consent form that included consent for publication.

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Rovirosa, A., Zhang, Y., Chargari, C. et al. Exclusive 3D-brachytherapy as a good option for stage-I inoperable endometrial cancer: a retrospective analysis in the gynaecological cancer GEC-ESTRO Working Group. Clin Transl Oncol 24, 254–265 (2022). https://doi.org/10.1007/s12094-021-02680-z

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