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To plan or not to plan? That is the question

2006; Elsevier BV; Volume: 5; Issue: 4 Linguagem: Inglês

10.1016/j.brachy.2006.08.002

1873-1449

William Small,

Colorectal and Anal Carcinomas

In this issue of Brachytherapy, Symon et al. investigate the relative benefits of individual fraction optimization (IFO) versus first fraction optimization (FFO) in the application of vaginal cuff high-dose-rate (HDR) brachytherapy ( [1] Symon Z. Menhal J. Alezra D. et al. Individual fraction optimization for multi-channel applicator vaginal brachytherapy. Brachytherapy. 2006; 5: 211-215 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar ). IFO refers to the planning and optimization of each brachytherapy implant as compared to applying the first planning and optimization to subsequent fractions without replanning (FFO). I applaud the authors' attempt to investigate optimal techniques to deliver vaginal cuff brachytherapy in endometrial cancer. Endometrial cancer is the most common gynecologic malignancy, with an estimated 41,200 cases in the United States in 2006 ( [2] Jemal A. Siegel R. Ward E. et al. Cancer statistics, 2006. CA Cancer J Clin. 2006; 56: 106-130 Crossref PubMed Scopus (5556) Google Scholar ). Traditional therapy for early endometrial cancer includes hysterectomy, lymph node staging and, in selected cases, adjuvant external beam radiotherapy. Recent randomized trials of pelvic radiotherapy versus observation after hysterectomy note the dominant pattern of recurrence in observed patients to be vaginal, suggesting a role for vaginal brachytherapy alone as adjuvant therapy for endometrial cancer ( 3 Creutzberg C. van Putten W.L.J. Kooper P.C.M. et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage I endometrial carcinoma: Multicentre randomized trial. Lancet. 2000; 355: 1404-1411 Abstract Full Text Full Text PDF PubMed Scopus (1546) Google Scholar , 4 Keys H.M. Roberts J.A. Brunetto V.L. et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: A Gynecologic Oncology Group study. Gynecol Oncol. 2004; 92: 744-751 Abstract Full Text Full Text PDF PubMed Scopus (1398) Google Scholar ). Recent institutional trials of vaginal cuff brachytherapy alone after hysterectomy have noted excellent local control rates with minimal toxicity ( 5 Small Jr., W. Zeytinoglu M. Keh R. et al. Endometrial adenocarcinoma invasive to ≤½ the myometrial thickness: Analysis of prognostic variables for recurrence and survival. Int J Radiat Oncol Biol Phys. 2001; 51: 35-36 Abstract Full Text Full Text PDF Google Scholar , 6 Anderson J.M. Stea B. Hallum A.V. et al. High dose rate postoperative vaginal cuff irradiation alone for stage IB and IC endometrial cancer. Int J Radiat Oncol Biol Phys. 2000; 46: 417-425 Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar , 7 Chadha M. Nanavati P.J. Liu P. et al. Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy. Gynecol Oncol. 1999; 75: 103-107 Abstract Full Text PDF PubMed Scopus (128) Google Scholar ). A recent survey performed by the American Brachytherapy Society (ABS) confirms that among American radiation oncologists there is an increasing trend toward recommending vaginal brachytherapy alone as an adjuvant therapy in endometrial cancer ( [8] Small Jr., W. Erickson B. Kwakwa F. An American Brachytherapy Society survey regarding the practice patterns of post-operative irradiation for endometrial cancer. Int J Radiol Oncol Biol Phys. 2005; 63: 1502-1507 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar ).