Author(s): Rper B, Astner ST, HeydemannObradovic A, Thamm R, Jacob V,
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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 : 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.
This article was published in Gynecol Oncol
and referenced in Journal of Biosensors & Bioelectronics