Primary radiotherapy for carcinoma of the endometrium using external beam radiotherapy and single line source brachytherapy

A small proportion of patients with adenocarcinoma of the endometrium are i noperable by virtue of severe concurrent medical conditions, gross obesity or advanced stage disease. They can be treated with primary radiotherapy wi th either curative or palliative intent. We report 37 such patients treated mainly with a combination of external beam radiotherapy and intracavitary brachytherapy using a single Line source technique. The 5-year disease-spec ific survival for nonsurgically staged patients was 68.4% for FIGO Stages I and II and 33.3% for Stages III and TV. The incidence of late morbidity wa s acceptably low. Using the France-Italian Glossary, there was 27.0% grade 1 but no grade 2-4 bladder toxicity. For the rectum the rates were 18.9% gr ade 1, 5.4% grade 2, 2.7% grade 3, and no grade 4 toxicity. Methods of opti mizing the dose distribution of the brachytherapy by means of variation of treatment length, radioactive source positions, and prescription point acco rding to tumour bulk and individual anatomy are discussed. The biologically equivalent doses (BED) for combined external beam radiotherapy and brachyt herapy were calculated to be in the range of 78-107 Gy(3) or 57-75 Gy(10) a t point 'A' and appear adequate for the control of Stage I cancers.