Clinical and Translational Oncology

, Volume 18, Issue 9, pp 925–930 | Cite as

Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients

  • I. RíosEmail author
  • A. Rovirosa
  • C. Ascaso
  • I. Valduvieco
  • A. Herreros
  • L. Castilla
  • S. Sabater
  • K. Holub
  • J. Pahisa
  • A. Biete
  • M. Arenas
Research Article



To analyze the vaginal-cuff local control (VCC) and toxicity in postoperative endometrial carcinoma patients (EC) underwent high-dose-rate brachytherapy (HDR-BT) administered daily.

Materials and methods

154 consecutive patients received postoperative HDR-BT for EC from January 2007 to September 2011. FIGO-staging I–IIIC2 patients were divided into two groups according to risk classification: Group 1 (94/154) included high-risk or advanced disease patients and Group 2 (60/154) included intermediate-risk EC patients. Group 1 underwent external beam irradiation (EBI) plus HDR-BT (2 fractions of 5 Gy) and Group 2 underwent HDR-BT alone (4 fractions of 5 Gy). Toxicity evaluation was done with RTOG scores for bladder and rectum, and the objective criteria of LENT–SOMA for vagina.


With a median follow-up of 46.7 months (36.6–61 months) only two patients developed vaginal-cuff recurrence in Group 1 (2.1 %) and none in group 2 (0 %). Early toxicity in Group 1 appeared 5.3 % in rectum, 7.5 % in bladder (G1–G2) and 2.1 % in vagina (G1); late toxicity was present in 7.3 % in rectum (all G1–G2 but 1 G3) and in 27.7 % in vagina (all G1–G2 but one G4). In Group 2, 6.7 % developed acute G1–G2 bladder and 6.6 % acute vaginal (G1–G2) toxicity. No late rectal or bladder toxicity was observed; 21.7 % of G1–G2 presented late problems in vagina.


The present HDR-BT schedule of 2 fractions of 5 Gy after EBI and 4 fractions of 5 Gy administered daily showed excellent results in terms of VCC and toxicity.


Endometrial cancer Gynecologic brachytherapy Brachytherapy schedules Endometrial cancer adjuvant treatment 



Grant AECC Scientific Foundation. This work was presented, in part, at the 33th ESTROFORUM Meeting. Barcelona 2015.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study group. Postoperative radiation therapy in endometrial carcinoma. Lancet. 2000;355:1404–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Querleu D, Planchamp F, Narducci F, Morice P, Joly F, Genestie C, et al. Clinical practice guidelines for the management of patients with endometrial cancer in France. Recommendations of the Institut National du Cancer and the Société Française d’Oncologie Gynécologique. Int J Gynecol Cancer. 2011;21:945–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Small W Jr, Beriwal S, Demanes DF, Dusenbery KE, Eifel P, Erickson B, et al. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012;11:58–67.CrossRefPubMedGoogle Scholar
  4. 4.
    Guinot JL, Pérez-Calatayud J, Azcoaga JM, Herruzo I, Bodineau C, Rovirosa A, et al. Consensus on treatment of endometrium carcinoma with brachytherapy. SEOR and the SEFM Brachytherapy Groups. Clin Transl Oncol. 2012;14:263–70.CrossRefPubMedGoogle Scholar
  5. 5.
    Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, Erickson B, et al. The role of postoperative radiation therapy for endometrial cancer: executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014;4:137–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Rovirosa A, Valduvieco I, Ascaso C, Herreros A, Arenas M, Rios I, et al. Comparative results of vaginal relapses and toxicity of two protracted 192-Ir HDR brachytherapy (BT) schedules in postoperative endometrial carcinoma (EC). Int J Radiat Oncol Biol Phys. 2014;90(15):S2712.Google Scholar
  7. 7.
    Rovirosa A, Valduvieco Rios I, Herreros A, Bautista C, Romera I, et al. Mid-term results of daily HDR brachytherapy in postoperative endometrial carcinoma. Rep Pract Oncol Radiother. 2013;18:S52.CrossRefGoogle Scholar
  8. 8.
    Rovirosa A, Ascaso C, Sánchez-reyes A, Herreros A, Abellana R, Pahisa J, et al. 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. 2011;81(2):418–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Valduvieco I, Rovirosa A, Herreros A, Romera I, Ríos I, Ascaso C, et al. Three or four fractions per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. The long-term results on vaginal relapses and toxicity. Clin Transl Oncol. 2013;15:602–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Creasman W. Revised Figo staging for carcinoma of endometrium. Int J Gynaecol Obstet. 2009;105:109.CrossRefPubMedGoogle Scholar
  11. 11.
    ICRU (1985) Report no. 38, dose and volume specification for reporting intracavitary therapy in gynaecology. In: Chassagne D, Dutreix A, Almond P, Burgers J, Busch M, Joslin C (eds) International commissioning on radiation units and measurements. Bethesda.Google Scholar
  12. 12.
    Late effects consensus conference. RTOG/EORTC. Radiother Oncol. 1995;35:5–7.CrossRefGoogle Scholar
  13. 13.
    LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Biol Phys. 1995;31:1049–91 (classification).Google Scholar
  14. 14.
    Rovirosa A, Valduvieco I, Ascaso C, Herreros A, Bautista C, Romera I, et al. Daily schedule for high-dose-rate brachytherapy in postoperative treatment of endometrial carcinoma. Clin Transl Oncol. 2013;15:111–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Townamchai K, Lee L, Viswanathan AN. A novel low dose fractionation regimen for adjuvant vaginal brachytherapy in early stage endometrioid endometrial cancer. Gynecol Oncol. 2012;127(2):351–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gaztañaga M, Cambeiro M, Villafranca Vila M, Jurado M, Moreno ME, et al. Long-term results of 1-week intravaginal high-dose-rate brachytherapy alone for endometrial cancer. Brachytherapy. 2012;11:119–24.CrossRefPubMedGoogle Scholar
  17. 17.
    Eiriksson L, Cuartero J, Steed H, Pearcey R, Capstick V, Schepansky A, et al. Assessment of outcomes in surgically staged I/II endometrial adenocarcinoma patients treated with postoperative vaginal vault radiotherapy only. Int J Gynecol Cancer. 2010;20:1356–62.PubMedGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  • I. Ríos
    • 1
    • 2
    Email author
  • A. Rovirosa
    • 1
  • C. Ascaso
    • 3
  • I. Valduvieco
    • 1
  • A. Herreros
    • 1
  • L. Castilla
    • 1
  • S. Sabater
    • 5
  • K. Holub
    • 1
  • J. Pahisa
    • 6
  • A. Biete
    • 1
  • M. Arenas
    • 4
  1. 1.Radiation Oncology Department, ICMHO, Functional Gynecologic Cancer UnitHospital Clinic UniversitariBarcelonaSpain
  2. 2.Radiation Oncology Department, Cancer InstituteCentro Medico ImbanacoCaliColombia
  3. 3.Public and Health Department, Medicine FacultyUniversitat de BarcelonaBarcelonaSpain
  4. 4.Radiation Oncology DepartmentHospital Sant Joan de ReusTarragonaSpain
  5. 5.Radiation Oncology DepartmentHospital General de AlbaceteAlbaceteSpain
  6. 6.Gynecological Surgery, Functional Gynecologic Cancer UnitHospital Clinic I UniversitariBarcelonaSpain

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