Post-operative high dose rate brachytherapy in patients with low to intermediate risk endometrial cancer

Background and purpose: This paper investigates the outcome using different dose/fractionation schedules in high dose rate (HDR) post operative vagina l Vault radiotherapy in patients with low to intermediate risk endometrial cancer. Materials and methods: The world literature was reviewed and thirteen serie s were analyzed representing 1800 cases. Results: A total of 12 vaginal vault recurrences were identified representi ng an overall vaginal control rate of 99.3%. A wide range of dose fractiona tion schedules and techniques have been reported. In order to analyze a dos e response relationship for tumor control and complications, the biological ly effective doses to the tumor and late responding tissues were calculated using the linear quadratic model. A threshold was identified for complicat ions, but not vaginal control. While dose fractionation schedules that deli vered a biologically effective dose to the late responding tissues in exces s of 100 Gy(3) (LQED = 60 Gy) predicted for late complications, dose fracti onation schedules that delivered a modest dose to the vaginal surface (50 G y(10) or LQED = 30 Gy) appeared tumoricidal with vaginal control rates of a t least 98%. Conclusions: By using convenient, modest dose fractionation schedules, HDR vaginal vault - brachytherapy yields very high local control and extremely low morbidity rates. (C) 2000 Elsevier Science Ireland Ltd. All rights rese rved.