Outpatient vaginal cuff brachytherapy for endometrial cancer

The objective of this study was to determine the efficacy and complications of postoperative high-dose-rate (HDR) vaginal-cuff brachytherapy (VCB) in patients with endometrial carcinoma. Between August 1989 to September 1997, 191 patients were treated postoperatively after a total abdominal hysterec tomy and bilateral salpingo-oophorectomy (TAH/ BSO) with outpatient adjuvan t HDR VCB for low-risk endometrial cancer (IB-84 %, grade 1 or 2-96 %). Pat ients were treated with 2 HDR fractions, delivered one week apart while und er conscious sedation (16.2 Gy X 2 to the vaginal surface). All clinical en dpoints were calculated using the Kaplan Meier method. The median time in t he brachytherapy suite was 60 min in which no acute complications were obse rved. The 30-day morbidity and mortality rates were both 0 %. With a median follow-up of 38 months (12-82 months), the 4-year survival, relapse-flee s urvival, and vaginal-control rates were 95 %, 98 %, and 100 %, respectively . One patient developed a cole-vaginal fistula at 5 years. Adjuvant HDR VCB in 2 outpatient insertions produced 100 % vaginal control rates with minimal morbidity. The advantages of high dose-rate compared to low dose-rate vaginal brachytherapy include patient convenience, markedly s horter treatment times (1 h per insertion), and reduction in the cost and p otential morbidity of hospitalization HDR brachytherapy approach is a cost- effective alternative to either low-dose-rate brachytherapy or whole pelvic radiotherapy in carefully selected patients.