Brachytherapy for early endometrial carcinoma: a comparative study with long-term follow-up

The current study was undertaken to evaluate the effect of preoperative ute rine or postoperative vaginal brachytherapy compared to no adjuvant therapy on the disease-free interval, sites of recurrence, and survival in favorab le stage IB endometrial carcinoma. One hundred and forty-six patients with FIGO grade 1 and 2 endometrial carc inoma and 1-33% myometrial invasion treated between 1974 and 1992 were retr ospectively studied. The use of brachytherapy varied among the treating phy sicians during the study period. A Kaplan-Meier survival analysis was used to estimate disease-free survival and differences between treatment groups were evaluated with the Mantel-Cox statistic. Recurrent disease occurred in 7 patients (5.3%). Vaginal recurrences accoun ted for 6 of the 7 sites of recurrences. Recurrences occurred in 1.3% of gr ade 1 vs. 8.7% of grade 2 tumors (P = 0.04). Among 69 grade 2 tumors, recur rences occurred in 7.5% of those treated with brachytherapy vs. 10.3% of th ose not treated (P = 0.68). Brachytherapy did not affect the disease-free o r overall survival. No serious complications directly related to therapy oc curred. Vaginal recurrences occur even in early endometrial carcinoma. This study d emonstrates no apparent benefit to brachytherapy. A larger study would be r equired to see a recurrence or survival difference.