PMID- 15850910
OWN - NLM
STAT- MEDLINE
DCOM- 20050607
LR  - 20051227
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 62
IP  - 1
DP  - 2005 May 1
TI  - Intravaginal brachytherapy alone for intermediate-risk endometrial cancer.
PG  - 111-7
AB  - PURPOSE: Despite the results of the Gynecologic Oncology Group trial No. 99 
      (GOG#99), some unanswered questions still remain about the role of adjuvant 
      radiotherapy (RT) for intermediate-risk endometrial cancer. First, can 
      intravaginal brachytherapy (IVRT) alone substitute for external beam RT but 
      without added morbidity? Second, is the high-risk (HR) definition from GOG#99 a 
      useful tool to predict pelvic recurrence specifically? The purpose of this study 
      was to try to answer these questions in a group of patients with Stage IB-IIB 
      endometrial carcinoma treated with high-dose-rate (HDR) IVRT alone. METHODS AND 
      MATERIALS: Between November 1987 and December 2002, 382 patients with Stage 
      IB-IIB endometrial carcinoma were treated with simple hysterectomy followed by 
      HDR-IVRT alone at our institution. Comprehensive surgical staging (CSS), defined 
      as pelvic washings and pelvic/paraaortic lymph node sampling, was performed in 
      20% of patients. The mean age was 60 years (range, 29-92 years). Lymphovascular 
      invasion (LVI) was present in 14% of patients. The median HDR-IVRT dose was 21 Gy 
      (range, 6-21 Gy), given in three fractions. Complications were assessed in terms 
      of late Radiation Therapy Oncology Group (Grade 3 or worse) toxicity of the GI 
      tract, genitourinary GU tract, and vagina. RESULTS: With a median follow-up of 48 
      months, the 5-year vaginal/pelvic control rate was 95% (95% confidence interval 
      [CI], 93-98%). On multivariate analysis, a poor vaginal/pelvic control rate 
      correlated with age > or =60 years old (relative risk [RR], 3, 95% CI, 1-12; p = 
      0.01), International Federation of Gynecology and Obstetrics (FIGO) Grade 3 (RR, 
      9, 95% CI, 2-35; p = 0.03), and LVI (RR, 4, 95% CI, 1-13; p = 0.051). The depth 
      of myometrial invasion and CSS, however, were not significant. With regard to 
      pelvic control specifically, the presence of GOG#99 HR features did not affect 
      the pelvic control rate. The 5-year rate for HR patients was 96% (95% CI, 
      90-100%) vs. 96% (95% CI, 94-99%) for those without HR disease (p = 0.48). Even 
      when the CSS effect was taken into account, the influence of HR features on 
      pelvic control was still not significant (p = 0.51). In contrast, pelvic control 
      was significantly influenced when patients were grouped according to CSS and 
      stage/grade substages. For those with Stage IB Grade 3-IIB and no CSS, the 5-year 
      pelvic control rate was 86% compared with 97% for those with Stage IB Grade 3-IIB 
      and CSS, 97% for Stage IB, Grade 1-2 without CSS, and 100% for those with Stage 
      IB, Grade 1-2 and CSS (p = 0.027). The 5-year disease-free survival rate was 93% 
      (95% CI, 90-96%). On multivariate analysis, poor disease-free survival correlated 
      with age > or =60 years (RR, 5; 95% CI, 1-18; p = 0.002), FIGO Grade 3 (RR 5, 95% 
      CI 2-17; p = 0.013), and LVI (RR 3, 95% CI 1-8; p = 0.054). Unlike pelvic 
      control, disease-free survival was significantly affected by GOG#99 HR features, 
      with a 5-year rate of 87% (95% CI, 76-99%) vs. 94% (95% CI, 91-97%) for those 
      without HR features (p = 0.027). The 5-year overall and disease-specific survival 
      rate was 93% and 97%, respectively. The overall 5-year actuarial rate of Grade 3 
      or worse complications was 1% (95% CI, 0-2%). CONCLUSION: Tumor grade, depth of 
      invasion, and the use of CSS were better predictors of pelvic control than the 
      GOG#99 HR factors. IVRT alone seemed to provide adequate tumor control with very 
      low morbidity. Therefore, it seems prudent to consider it for intermediate-risk 
      patients because of its superior therapeutic ratio compared with that for surgery 
      alone or pelvic RT. Additional follow-up, however, with a larger number of 
      patients is needed, especially for those with LVI.
FAU - Alektiar, Kaled M
AU  - Alektiar KM
AD  - Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New 
      York, NY 10021, USA. alektiak@mskcc.org
FAU - Venkatraman, Ennapadam
AU  - Venkatraman E
FAU - Chi, Dennis S
AU  - Chi DS
FAU - Barakat, Richard R
AU  - Barakat RR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
CIN - Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1275; author reply 1275. PMID: 
      16253783
MH  - Aged
MH  - Aged, 80 and over
MH  - Brachytherapy/adverse effects/*methods
MH  - Carcinoma, Endometrioid/pathology/*radiotherapy/surgery
MH  - Confidence Intervals
MH  - Disease-Free Survival
MH  - Endometrial Neoplasms/pathology/*radiotherapy/surgery
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Neoplasm Recurrence, Local
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Adjuvant
MH  - Risk
EDAT- 2005/04/27 09:00
MHDA- 2005/06/09 09:00
CRDT- 2005/04/27 09:00
PHST- 2004/07/21 00:00 [received]
PHST- 2004/09/16 00:00 [accepted]
PHST- 2005/04/27 09:00 [pubmed]
PHST- 2005/06/09 09:00 [medline]
PHST- 2005/04/27 09:00 [entrez]
AID - S0360-3016(04)02708-7 [pii]
AID - 10.1016/j.ijrobp.2004.09.054 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2005 May 1;62(1):111-7. doi: 
      10.1016/j.ijrobp.2004.09.054.