Vaginal brachytherapy as effective as whole pelvic radiation

NEW YORK (Reuters Health) – High-dose rate vaginal brachytherapy delivered as adjuvant therapy for intermediate-risk endometrial carcinoma appears to offer similar benefit to that of whole-pelvic radiation therapy, but with less toxicity and at lower cost.

Dr. Neil S. Horowitz, of the Swedish Medical Center in Seattle, and colleagues evaluated the outcomes of 164 women treated for FIGO stage IB, IC or II endometrial cancer. Surgical treatment included total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy.

As described in the February issue of Obstetrics and Gynecology, brachytherapy comprised three biweekly treatments begun by the fourth postoperative week. The total dose was 2100 cGy given to a depth of 0.5 cm into the vaginal mucosa in the proximal 5 cm of the vagina.

With a median follow-up of 65 months, 14 women experienced relapse. The investigators project a 5-year disease-free survival rate of 90%. Seven patients died of recurrent endometrial carcinoma. After correcting for eight intercurrent deaths, the 5-year survival rate was 95%.

"Our study, in conjunction with others, adds to the growing body of literature suggesting that vaginal vault brachytherapy is equivalent to whole-pelvic radiation in reducing local recurrences and increasing disease-free survival," the investigators write.

None of the patients experienced grade 3 or 4 gastrointestinal, genitourinary or cutaneous toxicities.

A comparison of Medicare relative value units shows that high dose vaginal brachytherapy costs approximately $1000 less than external beam therapy. Dr. Horowitz and his associates advocate the inclusion of high-dose rate vaginal brachytherapy in future randomized trials of adjuvant therapy for endometrial carcinoma.

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