IS THERE A ROLE FOR A BRACHYTHERAPY VAGINAL CUFF BOOST IN THE ADJUVANT MANAGEMENT OF PATIENTS WITH UTERINE-CONFINED ENDOMETRIAL CANCER

Purpose/Objective: Many patients who have uterine-confined endometrial cancer with prognostic factors predictive of recurrence are treated w ith adjuvant pelvic radiation. The addition of a brachytherapy vaginal cuff boost is controversial. Materials and Methods: Between 1983 and 1993, 270 patients received adjuvant postoperative pelvic irradiation following hysterectomy for Stage I or II endometrial cancer. Group A i ncludes 173 patients who received external beam irradiation alone (EBR T), while group B includes 97 patients who received EBRT with a vagina l brachytherapy application. The median dose of EBRT was 45 Gy. Vagina l brachytherapy consisted of a low dose rate ovoid or cylinder in 41 p atients, a high dose rate cylinder in 54 patients, and a radioactive g old seed implant in two patients. The median follow-up time was 61 mon ths. The two groups were compared in terms of age, histologic grade, f avorable versus unfavorable histology, capillary space invasion, depth of myometrial invasion, and pathologic stage. Results: Chi-square ana lysis revealed that the only difference between the two groups was the presence of more Stage II patients in group B (38% versus 14%). No di fference was detected for 5 year pelvic control and disease-free survi val rates between groups A and B. Conclusion: There is no suggestion t hat the addition of a vaginal cuff brachytherapy boost to pelvic radia tion is beneficial for pelvic control or disease-free survival for pat ients with Stage I or II endometrial cancer. Prospective randomized tr ials designed to study external irradiation alone versus external beam treatment plus vaginal brachytherapy are unlikely to show a positive result. Because EBRT provides excellent pelvic control, protocol devel opment for uterine-confined corpus cancer should focus on identifying patients at risk for recurrence as well as other means of augmenting E BRT (e.g. addition of chemotherapy) in order to improve disease free s urvival in those subgroups. (C) 1998 Elsevier Science Inc.