Gynecological Cancer

PV 04 - Poster Viewing Q&A - Session 4

TU_43_2796 - Prognostic Determinants of Salvage Image-Guided Brachytherapy for Vaginal Recurrence of Endometrial Cancer

Tuesday, September 17
2:45 PM - 4:00 PM
Location: ASTRO Innovation Hub

Prognostic Determinants of Salvage Image-Guided Brachytherapy for Vaginal Recurrence of Endometrial Cancer
G. Alban1, T. Cheng2, P. C. Li3, P. Y. McLaughlin1, L. Singer1, J. Pretz1, M. King2, and L. J. Lee1; 1Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 2Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, 3Massachusetts General Hospital/Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA

Purpose/Objective(s): In PORTEC-1, the 5-year survival after vaginal relapse from early stage endometrial cancer was 65% for patients in the observation arm. In this study, we evaluated clinical outcomes and toxicity in patients with vaginal relapse of endometrial cancer treated with salvage image-guided brachytherapy (BT).

Materials/Methods: Retrospective review identified 62 patients with early stage endometrial cancer and biopsy-proven vaginal recurrence treated with external beam (EBRT) and image-guided BT with definitive intent between 10/04 and 05/17. All patients had prior hysterectomy without adjuvant radiotherapy (RT) and >3 months follow-up (FU). Rates of vaginal control (VC), recurrence-free survival (RFS) and overall survival (OS) were estimated by Kaplan-Meier method. Univariate analysis was performed by Cox proportional hazards or logrank test. Late toxicity was graded by CTCAE. Median FU was 31.8 months (r: 3.2 – 160.5).

Results: Baseline characteristics are summarized in table 1. The median time to recurrence after hysterectomy was 18.2 months (range [r]: 1.6 – 158). Median tumor size was 2.3 cm (r: 0.3-7.5). Median prescribed dose and HR-CTV D90 in EQD2 were 75.4 Gy and 75.3 Gy, respectively. Twenty patients had disease relapse at a median of 14.2 months after completion of BT (6 with vaginal failure only, 2 vaginal and distant, and 12 distant only). The 3-year rates of VC, RFS and OS were 86%, 70% and 80%. respectively. Tumor grade at hysterectomy was a strong determinant of outcome, with 3-year RFS rates of 80% for grade 1 tumors, 78% for grade 2, and 13% for grade 3 (p<0.01). Age, stage at diagnosis, nodal involvement and BT modality were not associated with RFS (all p>0.2). Median HR-CTV D90 was 75.7 Gy for patients with vaginal failure and 75.2 Gy for those without (p=0.9). Age, BT modality, tumor grade, tumor size and cumulative prescribed dose were not prognostic for VC (all p>0.5). Late grade 3 toxicity included 2 patients with proctitis and 1 with urinary incontinence; all received interstitial BT. One cylinder patient had grade 3 vaginal stenosis.

Conclusion: Salvage RT with image-guided BT results in excellent clinical outcomes for patients with grade 1 or 2 tumors and vaginal relapse. Those with grade 3 tumors or non-endometrioid histologies have high rates of distant recurrence and poor survival. Adjuvant treatment should be considered for all high risk patients given the low rates of salvage. Table 1.Baseline characteristics for 62 patients
n (%)
FIGO 2009 stage at diagnosis
  • IA
  • IB
  • II
  • 56 (90%)
  • 5 (8%)
  • 1 (2%)
Histology
  • Endometrioid
  • Serous
  • Carcinosarcoma
  • 55 (89%)
  • 5 (8%)
  • 2 (3%)
Grade
  • 1
  • 2
  • 3
  • 40 (65%)
  • 13 (21%)
  • 9 (14%)
Median age at recurrence
67 years (r: 41-86)
Site(s) of recurrence
  • Vaginal only
  • Vaginal + nodal
  • 55 (89%)
  • 7 (11%)
Image-guided BT modality
  • Intracavitary (cylinder)
  • Interstitial
  • 26 (42%)
  • 36 (58%)
Median central EBRT dose
  • 45Gy (r: 44 – 54)
Median BT dose
  • 25Gy (r: 16 – 35)
Median D2cc OAR
  • Bladder
  • Rectum
  • Sigmoid
  • 65.8 Gy (r: 50.7 – 87.2)
  • 64.7 Gy (r: 52.1 – 86.9)
  • 53.7 Gy (r: 44.7 – 75.5)
Chemotherapy use 11 (18%)

Author Disclosure: G. Alban: None. P.C. Li: None. P. McLaughlin: None. L. Singer: None. L.J. Lee: Research Grant; Dana-Farber Cancer Institute, Joint Center of Radiation Therapy, Astra Zeneca, Bridge Expansion Grant. Employee; Brigham and Women's Physician Organization.

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