Radiation Oncology/Endometrium/Recurrence

Treatment of recurrent disease

Vaginal recurrence

• Washington U., 2005 (1967-2003) PMID 16168841 — "Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer." Lin LL et al. Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):500-4.
  • Retrospective. 50 pts treated for recurrence after tah/bso. Treatment was EBRT alone (6%), brachytherapy alone 16%, or EBRT + brachy (78%). Median dose to recurrence 60 Gy.
  • Median f/u 58 mo. 5-yr and 10-yr DFS 68% and 55%, OS 53% and 40%.
  • Conclusion: cure is possible in over 50% of pts.
• MDACC, 2003 (1960-97) PMID 12873682 -- "Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy." (Jhingran A, Int J Radiat Oncol Biol Phys. 2003 Aug 1;56(5):1366-72.)
  • Retrospective, 91 pts. Treatment was EBRT alone (31%), brachy alone (12%), or EBRT + brachy (57%). Median total dose 75 Gy; median EBRT dose 50 Gy.
  • Median f/u 58 mo. LC 2yr-85%, 5yr-75%; OS 2yr-69%, 5yr-43%. Combination treatment was associated with better control.
  • Conclusion: RT provides excellent LC
• PORTEC-1, 2003 (1990-97) PMID 12713981 -- "Survival after relapse in patients with endometrial cancer: results from a randomized trial." (Creutzberg CL, Gynecol Oncol. 2003 May;89(2):201-9.)
  • Patients treated in the PORTEC trial (see here), randomized to either adjuvant RT or observation.
  • 39 pts with isolated vaginal relapse; 31 of these treated with curative intent (usually RT+brachy). CR obtained in 31 of 35 (89%), with long term control in 24 of 31 (77%). Total long term control rate is thus 24/35 (68%).
  • Survival after 1st relapse at 3 yrs: 51% (control group) vs 19% (RT).
  • Survival after vaginal relapse 73%, after pelvic relapse 8%, after DM relapse 14%.

HDR Brachytherapy:

• Montreal (Hôpital Notre-Dame) (1997-2003)
  • 2006 PMID 16386785 -- "Salvage treatment with high-dose-rate brachytherapy for isolated vaginal endometrial cancer recurrence." (Petignat P, Gynecol Oncol. 2006 Jun;101(3):445-9.)
  • 22 pts; 18 treated with combined EBRT + HDR, and 4 with HDR alone. Median EBRT dose 45 Gy. Brachytherapy dose median 26 Gy (range: 8-48 Gy).
  • CR in 100%. No LR after median f/u of 32 mo.
  • Conclusion: salvage treatment with EBRT + HDR is efficacious

• McGill University
  • 1997 PMID 9264580 -- "Isolated vaginal recurrences in endometrial carcinoma: treatment results using high-dose-rate intracavitary brachytherapy and external beam radiotherapy." (Pai HH, Gynecol Oncol. 1997 Aug;66(2):300-7.)
  • 20 pts; 13 treated with combined EBRT + HDR, and 7 with HDR alone. Median EBRT dose 44 Gy and 24 Gy HDR to vaginal surface. For HDR alone, median dose 35 Gy.
  • CR in 90%. 10-yr LC 74%.
  • Conclusion: salvage treatment with EBRT + HDR is efficacious