Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy

Objective. The vagina is the most common site of locoregional failure in su rgical stage IB, IC, and II (occult) endometrial adenocarcinoma. The object ive of this study is to evaluate the therapeutic efficacy of vaginal vault brachytherapy alone for surgical stage I patients with high-risk features. Materials and methods. The study group consists of high-risk stage I patien ts with either stage IB grade (G)3 or any grade IC disease. From February 1 991 to August 1997, 124 patients with endometrial carcinoma were treated po stoperatively with high-dose-rate vaginal vault brachytherapy as the only a djuvant treatment. All patients were surgically staged. Among them, 38 pati ents were identified as high risk. Twelve patients had stage IBG3, 14 had I CG1, 9 had ICG2, and 3 had ICG3 disease. The median age was 67 years (range 41 to 86 years). A dose of 21 Gy in three fractions of 7 Gy each was deliv ered to a prescription depth of 0.5 cm from the surface of the vaginal appl icator using high-dose-rate brachytherapy. Results. The median follow-up was 30 months (range 7 to 91 months). No pati ent has developed a vaginal or pelvic recurrence. Three patients developed tumor recurrence in the upper abdomen at 11, 18, and 37 months. Two of the three patients with recurrent disease also had history of breast cancer. In one patient, breast cancer was diagnosed 4.8 years prior and in the second 3 years subsequent to the diagnosis of endometrial cancer. The 5-year actu arial overall survival and disease-free survival are 93 and 87%, respective ly. There was no treatment-related grade 3 or 4 morbidity observed. Conclusions. For patients with surgical stage IBG3 and IC, excellent local control and minimal morbidity has been observed with the selective use of v aginal brachytherapy alone. Further studies and longer follow-up are warran ted, (C) 1999 Academic Press.