Three or Four Fractions of 4–5 Gy per Week in Postoperative High-Dose-Rate Brachytherapy for Endometrial Carcinoma

Rovirosa, Angeles; Ascaso, Carlos; Sánchez-Reyes, Alberto; Herreros, Antonio; Abellana, Rosa; Pahisa, Jaume; Lejarcegui, Jose Antonio; Biete, Albert

doi:10.1016/j.ijrobp.2010.06.001

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Volume 81, Issue 2 , Pages 418-423, 1 October 2011

Three or Four Fractions of 4–5 Gy per Week in Postoperative High-Dose-Rate Brachytherapy for Endometrial Carcinoma

Angeles Rovirosa, M.D., Ph.D.
- Radiation Oncology Department, Hospital Clinic, Institut d'Investicació Biomédica Agustí Pi i Sunyer, Barcelona, Spain
- Reprint requests to: Angeles Rovirosa, M.D., Ph.D., Radiation Oncology Department, Hospital Clínic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain. Tel and Fax: (+34) 932275542
Carlos Ascaso, Ph.D.
- Public Health Department, University of Barcelona, IDIBAPS, Spain
Alberto Sánchez-Reyes, Ph.D.
- Radiation Oncology Department, Hospital Plató, Barcelona, Spain
Antonio Herreros
- Radiation Oncology Department, Hospital Clinic, Institut d'Investicació Biomédica Agustí Pi i Sunyer, Barcelona, Spain
Rosa Abellana, M.D., Ph.D.
- Public Health Department, University of Barcelona, IDIBAPS, Spain
Jaume Pahisa, M.D., Ph.D.
- Gynecology and Obstetrics Department, Hospital Clinic, Barcelona, Spain
Jose Antonio Lejarcegui, M.D., Ph.D.
- Gynecology and Obstetrics Department, Hospital Clinic, Barcelona, Spain
Albert Biete, M.D., Ph.D.
- Radiation Oncology Department, Hospital Clinic, Institut d'Investicació Biomédica Agustí Pi i Sunyer, Barcelona, Spain

Received 11 January 2010; received in revised form 16 March 2010; accepted 7 June 2010. published online 27 August 2010.

Purpose

To evaluate the results of high-dose-rate brachytherapy (HDRBT) using a schedule of three or four fractions per week, when possible, in 89 patients on local control and toxicity in postoperative treatment of endometrial carcinoma. The effect of the overall HDRBT treatment time (OTT) on toxicity was also evaluated.

Patients and Methods

Fédération Internationale de Gynécologie Obstétrique Stage: 24 IB, 45 IC, 4 IIA, 6 IIB, 4 IIIA, 2 IIIB, and 4 IIIC. Radiotherapy: Group 1—67 of 89 patients received external beam irradiation (EBI; 44–50 Gy) plus HDRBT (3 fractions of 4–6 Gy); Group 2—22 of 89 patients received HDRBT alone (6 fractions of 4–5 Gy). OTT: Group 1—HDRBT was completed in a median of 5 days in 32 patients and in >5 days in 35; Group 2—HDRBT was completed in <15 days in 11 patients and in ≥16 days in 11. Toxicity was evaluated using Radiation Therapy Oncology Group scores and the bioequivalent dose (BED) study was performed in vaginal mucosa surface. Statistics included Student's t test, chi-square test, and receiving operator curves.

Results

With a mean follow-up of 31 months (range, 6–70), 1 of 89 patients had vaginal relapse. Early toxicity appeared in 8 of 89 (9%) patients and was resolved. Late toxicity appeared in 13/89 (14%): vaginal nine Grade 1, three Grade 2, one Grade 4; bladder two Grade 2; rectal three Grade 1, one Grade 2. No differences were found in relation to OTT in Groups 1 and 2. Mean BED was 88.48 Gy in Group 1 and 165.28 Gy in Group 2. Cases with Grade 2 late vaginal toxicity received >75 Gy after EBI and >165 Gy in Group 2.

Conclusions

Three fractions of 4–5 Gy in 3–5 days after EBI or 6 fractions in <15 days in patients receiving HDRBT alone was a safe treatment in relation to toxicity and local control. Vaginal surface BED less than 75 Gy after EBI and less than 160 Gy in HDRBT alone may be safe to avoid G2 toxicity.

Endometrial carcinoma, Postoperative HDR brachytherapy