PERINEAL TEMPLATE INTERSTITIAL BRACHYTHERAPY SALVAGE FOR RECURRENT ENDOMETRIAL ADENOCARCINOMA METASTATIC TO THE VAGINA

Purpose: To evaluate the use of interstitial brachytherapy salvage of recurrent endometrial adenocarcinoma metastatic to the vagina. Methods : From September 1989 to February 1995, 15 patients with locally recur rent endometrial adenocarcinoma were treated with perineal template in terstitial irradiation with low-dose-rate brachytherapy Ir-192/Cs-137. Five of the 7 previously unirradiated patients received pelvic extern al beam radiation therapy (EBRT) of 45-50 Gy, with standard fractionat ion followed by an interstitial brachytherapy boost dose of 30 Gy (ran ge 25 to 35 Gy). The other 2 patients received only brachytherapy of 4 0 Gy (palliative) and 50 Gy. Eight previously irradiated patients rece ived only brachytherapy of 50 to 55 Gy. Results: After a median follow -up of 47 months (range 14-81), the actuarial local control rate was 6 6.6%. The local control rate for patients treated with interstitial ir radiation only was 64.3% and the local control rate for patients treat ed with interstitial irradiation + EBRT was 100%. Distant metastases o ccurred in 30.7% of the patients. Actuarial overall and disease-specif ic 5-year survival were 42.3 and 67.5%, respectively. Toxicity has bee n minimal, with 6 patients complaining of vaginal/rectal (RTOG) grade 1-3 complications (5 patients grade 1-2, 1 patient grade 3). Conclusio ns: These results suggest that perineal template interstitial irradiat ion (if possible with supplementary EBRT) is an effective alternative to radical or exenterative pelvic surgery for locally recurrent endome trial cancer. Excellent survival and local control rates can be achiev ed with low morbidity, especially if EBRT is added. (C) 1997 Academic Press.