Portal de Periódicos da CAPES

Outcomes and Toxicity Following Adjuvant Vaginal Brachytherapy for Stage I and II Endometrial Cancer Using 30 Gy in 6 fractions – An Institutional Analysis

2019; Elsevier BV; Volume: 105; Issue: 1 Linguagem: Inglês

10.1016/j.ijrobp.2019.06.1668

1879-355X

Jonathan Dokter, K. Marvin, S.R. Nandalur, Zaid Al-Wahab, J.A. Rakowski, Jayson B. Field, Jill Gadzinski, Barry P. Rosen, M.S. Jawad,

Ovarian cancer diagnosis and treatment

To evaluate outcomes and toxicity following adjuvant vaginal cuff brachytherapy (VBT) for FIGO Stage I-II endometrial cancers. 226 patients with FIGO Stage I-II endometrial cancer underwent adjuvant HDR VBT as monotherapy from 1992-2018 (200 Stage I, 26 Stage II). Patients had TAH/TLH-BSO ± LND prior to VBT. All patients received 30 Gy/6 fx (BED 45Gy, EQD2 37.5Gy) to the upper ⅓ of the vagina (4 cm in 91%) at 5 mm depth, delivered twice weekly over 3 wks. Acute and chronic GYN/GU/GI toxicities were defined as side effects ≤ 6 mos and > 6 mos post-VBT, respectively. Toxicity was graded according to CTCAE v4.0. Clinical outcomes analyzed include local recurrence (LR), regional recurrence (RR), distant metastases (DM), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS). Outcomes were analyzed using t-tests for continuous variables, χ2 for categorical variables, and Kaplan-Meier estimates. P-values < 0.05 were considered significant. Median follow-up was 5.6 yrs (0-24.5). Median age was 65 (31-89). The majority were endometrioid histology (69%), with the remainder representing papillary serous, MMMT, clear cell, or mixed. FIGO stage was IA in 48%, IB in 41%, and II in 11%. Tumors were gr 1 in 39%, gr 2 in 30%, gr 3 in 30%, and unknown in 1%. LVSI was present in 73 patients (32%). Some patients with high risk histology underwent adjuvant chemotherapy (22%). Acute and chronic toxicity data was available for 190 and 158 patients, respectively. Table 1 lists common toxicities. The most common gr 1 acute toxicities were fatigue (11%), frequency (12%), and vaginal discharge (10%). All others were < 10%. The most common gr 1 chronic toxicities were frequency (13%), incontinence (12%), and vaginal stenosis (18%). All others were < 10%. There were few gr 2 toxicities, ranging from 0-4% overall. There were no gr 3/4/5 acute or chronic toxicities. Overall clinical outcomes were excellent. LR and RR was 4.7% and 4.1%, respectively, at 5 yrs. 5-yr DM was 5%, OS 91%, CSS 93%, and DFS 83%. Our dose fractionation was selected prior to ABS guideline publication, in order to deliver adequate dose while decreasing fraction size to minimize toxicity. This analysis suggests that 30 Gy/6 fx results in excellent clinical outcomes with no gr 3 or higher toxicity. Laparoscopic/robotic-assisted surgeries became routine at our institution in 2006. Our cohort represented women treated before and after this, and LR is overall low. Further study is planned to analyze whether LVSI and/or surgery played a role in LR.Abstract 2802; Table 1Acute (N=190) and Chronic (N=158) GYN/GU/GI ToxicitiesToxicityAcute (N%)Chronic N (%)Gr 1Gr 2Gr 1Gr 2Frequency/Urgency23 (12)0 (0)21 (13)3 (2)Dysuria2 (1)0 (0)2 (1)0 (0)Urinary Incontinence8 (4)6 (3)19 (12)5 (4)Diarrhea13 (7)1 (0.5)9 (6)1 (0.5)Rectal Pain0 (0)0 (0)4 (2)0 (0)Vaginal Stenosis3 (1.5)1 (0.5)28 (18)3 (2)Vaginal Discharge19 (10)1 (0.5)13 (8)1 (1)Vaginal Dryness1 (0.5)4 (2)3 (2)7 (4)Vaginal Infection1 (0.5)1 (0.5)4 (2)0 (0) Open table in a new tab