Radiation therapy as exclusive treatment for medically inoperable patients with stage I and II endometrioid carcinoma with endometrium.

Fishman

The 5-year actuarial cancer-specific survivals for patients with Stage I inoperable, Stage 11 inoperable, Stage I operable, and Stage II operable disease were 80, 85, 98, and 100%. The corresponding 5-year overall survival rates were 30, 24, 88, and 85%. Inoperable patients had a significantly shorter overall survival and more deaths due to intercurrent disease than operable patients (P < 0.0001). However, inoperable patients who did not die from intercurrent disease had a median 5-year survival which approaches that of operable patients. Our study demonstrates that exclusive radiation therapy is a well-tolerated and effective treatment for medically inoperable patients.

Int J Radiat Oncol Biol Phys 1997 Jan 15;37(2):359-65

Primary treatment of endometrial carcinoma with high-dose-rate brachytherapy: results of 12 years of experience with 280 patients.

Knocke

HDRB was performed four to five times (8.5 Gy) with a one-channel intracavitary applicator and one to two times (7 Gy) with an intravaginal cylinder applicator.  At 5 years, overall survival, disease-specific survival, and local control were 52.7%, 76.6%, and 75.4% (Stage Ia: 63.9%, 84.9%, and 86.0%; Stage Ib: 47.3%, 73.3%, and 68.8%; and Stage II: 40.2%, 68.6%, and 60.5%) The calculated probability for developing a Grade III late side effect was 5.2% at 5 years. CONCLUSION: At Stages Ia, Ib, and II in endometrial carcinoma, HDRB is a very effective treatment modality with acceptable local control rates and disease-specific survival for patients who are not fit for surgery. During the time frame of 12 years and in 280 patients the method has proven to have a low risk of acute complications and an acceptable risk of long-term side effects.

Acta Obstet Gynecol Scand 1998 Nov;77(10):1008-12

Treatment of endometrial carcinoma with high-dose-rate brachytherapy alone in medically inoperable stage I patients.

Kucera

All patients received an exclusive radiation therapy by means of high-dose-rate Iridium 192 intracavitary brachytherapy without additional external beam radiation. RESULTS: At 5 years, the overall survival rate was 59.7% and disease specific survival 85.4% at 10 years 30.2% and 75.1%. The calculated probability of severe complications was 4.6% at 5 years. CONCLUSION: HDR brachytherapy alone achieves excellent disease specific survival rates in patients with medically inoperable stage I endometrial carcinoma.

Gynecol Oncol 1998 Nov;71(2):196-203

High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer.

Nguyen,  Petereit

Patients received 5 weekly HDR outpatient brachytherapy applications while under intravenous conscious sedation. With a median follow-up of 32 months the 3-year uterine control, disease-free survival, survival, and complications were 88, 85, 65, and 21%, respectively. CONCLUSION: Excellent uterine control rates (88%) were achieved using HDR brachytherapy for patients with medically inoperable endometrial cancer, but with significant acute and late morbidities. These toxicities were observed in a previous interim analysis that resulted in major modifications of the HDR program. No severe complications have developed since these changes were implemented. The current approach used for these challenging inoperable patients is a viable alternative to observation or hormonal therapy.

Gynecol Oncol 1995 Dec;59(3):370-5

High-dose-rate brachytherapy as the primary treatment of medically inoperable stage I-II endometrial carcinoma.

Nguyen

Patients were treated with high-dose-rate brachytherapy (HDRB) alone (19/27) or with a combination of external-beam RT and HDRB (2 stage I; 6 stage II). HDRB was delivered using a cobalt-60 HDR remote afterloading unit, with a median dose of 2000 cGy to point A, in two to three fractions given once a week. External-beam irradiation to the pelvis was given using 4- to 6-MV photons and a median dose of 4200 cGy was delivered.  With a median follow-up of 47 months, the 8-year disease-specific survival rate was 76%. Patients with stage I had an 8-year survival rate superior to that of patients with stage II (95% vs 21%, P < 0.001). No complications were experienced during HDRB. Late serious complications were seen in 3 patients (11%). Based on this retrospective review, primary RT with HDRB appears to be an effective and safe treatment for those patients with medically inoperable clinical stage I endometrial carcinoma. However, in stage II disease the results of treatment are poor and RT alone should be considered only when the surgical risks are too high.