Treatment Results of Adjuvant Brachytherapy as Monotherapy in Endometrial Cancer: A Retrospective Study from Faculty of Medicine, Chiang Mai University

Ekkasit Tharavichitkul^1*, Sukon Prasitwattanaseree², Cholthicha Thipmate², Somvilai Chakrabandhu¹, Pitchayaponne Klunklin¹, Wimrak Onchan¹, Razvan M. Galalae³, Imjai Chitapanarux¹

¹The Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
²Biostatistics and Applied Statistics Laboratory, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.
³Faculty of Medicine, Christian-Albretch University, Kiel, Germany.

DOI: 10.4236/jct.2015.61005                

Abstract

Purpose: To report the retrospective study of using intravaginal brachytherapy as adjuvant monotherapy for endometrial cancer. Materials and Methods: From 2001-2009, 47 patients who received completely surgical staging for endometrial carcinoma and were designed by multidisciplinary team were enrolled. All patients received intravaginal brachytherapy (IVBT) with the dose of 5.5 - 7 Gy in 2 - 6 fractions. The treatment results and late toxicities were evaluated and recorded. Results: At the median follow-up time of 44 months, the local control, disease-free survival, metastasis-free survival and overall survival rates were 100%, 97.9%, 97.9% and, 97.9%, respectively. Only age showed the statistical significance with the p-value of 0.046. Two patients (4.3%) developed late genitourinary toxicity. Conclusion: The using of adjuvant IVBT as monotherapy for endometrial carcinoma is feasible.

Keywords

Endometrial Cancer, Adjuvant, Brachytherapy, Monotherapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Tangjitgamol, S., Manusirivithaya, S., Srijaipracharoen, S., Khunnarong, J., Tanvanich, S., Katanyu, K., et al. (2010) Endometrial Cancer in Thai Women: Clinico-Pathological Presentation and Survival. Asian Pacific Journal of Cancer Prevention, 11, 1267-1272.
[2]	Keys, H.M., Roberts, J.A., Brunetto, V.L., Zaino, R.J., Spirtos, N.M., Bloss, J.D., et al. (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. Gynecologic Oncology, 92, 744-751. http://dx.doi.org/10.1016/j.ygyno.2003.11.048
[3]	Creutzberg, C.L., van Putten, W.L., Koper, P.C., Lybeert, M.L., Jobsen, J.J., Wárlám-Rodenhuis, C.C., et al. (2000) Surgery and Postoperative Radio-Therapy versus Surgery Alone for Patients with Stage-1 Endometrial Carcinoma; Multicenter randomized Trial. Lancet, 355, 1404-1411. http://dx.doi.org/10.1016/S0140-6736(00)02139-5
[4]	ASTEC/EN.5 Study Group, Blake, P., Swart, A.M., Orton, J., Kitchener, H., Whelan, T., Lukka, H., et al. (2009) Adjuvant External Beam Radiotherapy in the Treatment of Endometrial Cancer (MRC ASTEC and NCIC-CTG EN.5 Randomised Trials): Pooled Trial Results, Systematic Review, and Meta-Analysis. Lancet, 373, 137-146. http://dx.doi.org/10.1016/S0140-6736(08)61767-5
[5]	Aalders, J., Abeler, V., Kolstad, P. and Onsrud, M. (1980) Postoperative External Irradiation and Prognostic Parameters in Stage I Endometrial Carcinoma: Clinical and Histopathologic Study of 540 Patients. Obstetrics & Gynecology, 56, 419-427.
[6]	Nout, R.A., Smit, V.T., Putter, H., Jürgenliemk-Schulz, I.M., Jobsen, J.J., Lutgens, L.C., 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. http://dx.doi.org/10.1016/S0140-6736(09)62163-2
[7]	Cox, J.D., Stetz, J. and Pajak, T.F. (1995) Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). International Journal of Radiation Oncology*Biology* Physics, 31, 1341-1346. http://dx.doi.org/10.1016/0360-3016(95)00060-C
[8]	Miller, A.B., Hoogstraten, B., Staquet, M. and Winkler, A. (1981) Reporting Results of Cancer Treatment. Cancer, 47, 207-214. http://dx.doi.org/10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6
[9]	Kaplan, E.L. and Meier, P. (1958) Non-Parametric Estimation from Incomplete Observations. Journal of the American Statistical Association, 53, 457-481. http://dx.doi.org/10.1080/01621459.1958.10501452
[10]	Mantel, N. (1966) Evaluation of Survival Data and Two New Rank Order Statistics Arising in Its Consideration. Cancer Chemotherapy Reports, 50, 163-170.
[11]	Cox, D.R. (1972) Regression Models and Life Tables. Journal of the Royal Statistical Society: Series B, 34, 187-220.
[12]	Hong, J.J., Yacoub, S.F., Blevins, J.C., Kuban, D.A. and El-Mahdi, A.M. (1997) High Dose Rate Vaginal Bracytherapyin Early Stage Endometrial Carcinoma: Preliminary Analysis. American Journal of Clinical Oncology, 20, 254-258. http://dx.doi.org/10.1097/00000421-199706000-00009
[13]	Chadha, M., Nanavati, P.J., Liu, P., Fanning, J. and Jacobs, A. (1999) Patterns of Failure in Endometrial Carcinoma Stage IB Grade 3 and IC Patients Treated with Postoperative Vaginal Vault Brachytherapy. Gynecologic Oncology, 75, 103-107. http://dx.doi.org/10.1006/gyno.1999.5526
[14]	McCloskey, S.A., Tchabo, N.E., Malhotra, H.K., Odunsi, K., Rodabaugh, K., Singhal, P., et al. (2010) Adjuvant Vaginal Brachytherapy Alone for High Risk Localized Endometrial Cancer as Defined by the Three Major Randomized Trials of Adjuvant Pelvic Radiation. Gynecologic Oncology, 116, 404-407. http://dx.doi.org/10.1016/j.ygyno.2009.06.027
[15]	Eldredge-Hindy, H.B., Eastwick, G., Anne, P.R., Rosenblum, N.G., Schilder, R.J., Chalian, R., et al. (2014) Adjuvant Vaginal Cuff Brachytherapy for High-Risk, Early Stage Endometrial Cancer. Journal of Contemporary Brachytherapy, 6, 262-270. http://dx.doi.org/10.5114/jcb.2014.45031