Ten-year data on 138 patients with endometrial carcinoma and postoperative vaginal brachytherapy alone: no need for external-beam radiotherapy in low and intermediate risk patients.

Röper, B; Astner, ST; Heydemann-Obradovic, A; Thamm, R; Jacob, V; Hölzel, D; Schmalfeldt, B; Kiechle-Bahat, M; Hoss, C; Molls, M

doi:10.1016/j.ygyno.2007.08.055

journal article

Titel:: Ten-year data on 138 patients with endometrial carcinoma and postoperative vaginal brachytherapy alone: no need for external-beam radiotherapy in low and intermediate risk patients.
Dokumenttyp:: Journal Article; Article
Autor(en):: Röper, B; Astner, ST; Heydemann-Obradovic, A; Thamm, R; Jacob, V; Hölzel, D; Schmalfeldt, B; Kiechle-Bahat, M; Hoss, C; Molls, M
Abstract:: OBJECTIVE: To evaluate long-term outcome, risk factors, and causes of death in stage I-IIIA endometrial carcinoma (EC) patients treated only with adjuvant vaginal brachytherapy (VB) and to clarify for which subgroups of patients it is safe to omit external-beam radiotherapy (EBRT). METHODS: Out of 224 EC patients receiving postoperative radiotherapy between 1990 and 2002, 138 had VB alone in curative intent (FIGO [2002]: 85%I, 12%II, 3%IIIA; 18 low risk [IA G1-2, IB G1], 103 intermediate risk [IB G2-3, IC G1-2, IIA-B G1-2], 17 high risk [IC G3, IIIA]). After surgery+/-lymphadenectomy, HDR-brachytherapy prescription (in 95.7% of patients) was 3x10 Gy to the surface or 3x5 Gy at 5 mm tissue depths. RESULTS: Median follow-up was 107 months (range 3-185). Three intermediate and 7 high risk-patients relapsed. The 10-year vaginal control was 99.2%, locoregional control was 95.2% (low/intermediate/high risk: 100%/98.9%/68.8%), and disease-free survival (DFS) was 91.7% (100%/96.8%/55.2%). Risk factors for poor DFS were lymphovascular space invasion, > or = 50% myometrial invasion (univariate, p<0.05), pathological FIGO-stage, and grade 3 (uni-/multivariate, p<0.05). Leading causes of deaths (n=41) were cardiovascular disease (29%) and other malignancies (24%) ahead of EC (19.5%). The 10-year overall survival was 68.5% and the disease-specific survival was 92.4%. Thirty-five secondary tumors in 31 patients led to a higher actuarial death rate (10-year 9.9%, 15-year 17.7%) than EC (7.6%). CONCLUSIONS: Restricting adjuvant therapy to VB alone seems to be safe in low and intermediate risk EC and can be recommended. As death rarely relates to early-stage EC, value of adjuvant therapy is probably better reflected by DFS rather than by overall survival.
Zeitschriftentitel:: Gynecol Oncol
Jahr:: 2007
Band / Volume:: 107
Heft / Issue:: 3
Seitenangaben Beitrag:: 541-8
Sprache:: eng
Volltext / DOI:: doi:10.1016/j.ygyno.2007.08.055
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/17884152
Print-ISSN:: 0090-8258
TUM Einrichtung:: Frauenklinik und Poliklinik; Klinik und Poliklinik für RadioOnkologie und Strahlentherapie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für RadioOnkologie und Strahlentherapie (Prof. Combs)2007

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Frauenheilkunde (Prof. Kiechle)2007