Definitive salvage for vaginal recurrence of endometrial cancer

The impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification

John A. Vargo, Hayeon Kim, Christopher J. Houser, Hebist Berhane, Paniti Sukumvanich, Alexander B. Olawaiye, Joseph L. Kelley, Robert P. Edwards, John T. Comerci, Marilyn Huang, Madeleine Courtney-Brooks, Sushil Beriwal

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: Data for salvage radiotherapy for recurrent endometrial cancer are limited especially in the era of modern radiotherapy including IMRT and 3-dimensional image-based HDR brachytherapy. Theoretically, modern radiotherapy reduces the dose to critical organs-at-risk and maximizes dose to the target volume, possibly decreasing morbidity and increasing tumor control. Materials and methods: Forty-one patients completing definitive salvage radiotherapy for vaginal recurrence of endometrial cancer from June 2004 to December 2013 were retrospectively reviewed. HDR Brachytherapy was completed using image-based planning with contouring/optimization with each fraction to a median dose of 23.75 Gy in 5 fractions. HDR brachytherapy was preceded by external beam radiotherapy predominately using an IMRT technique (90%) to a median dose of 45 Gy in 25 fractions. Toxicity was reported according to CTCAEv4. Results: At a median follow-up of 18 months (range: 3-78), the clinical complete response rate was 95%. The 3-year local control, distant control, recurrence free survival, and overall survival were 95%, 61%, 68%, and 67%. Significant predictors of both distant failure and overall survival were primary prognostic factors of depth of myometrial invasion, FIGO stage, and FIGO grade. There was no grade 3+ acute toxicity; the 3-year rate of grade 3+ late toxicity was 8%. Conclusions: Salvage IMRT plus 3-dimensional image-based HDR brachytherapy shows excellent tumor control and minimal morbidity for vaginal recurrence of endometrial cancer. Anticipated salvage rates must be taken in the context of primary risk factors including depth of myometrial invasion, FIGO stage, and FIGO grade.

Original languageEnglish (US)
Pages (from-to)126-131
Number of pages6
JournalRadiotherapy and Oncology
Volume113
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Intensity-Modulated Radiotherapy
Brachytherapy
Endometrial Neoplasms
Radiotherapy
Recurrence
Survival
Organs at Risk
Morbidity
Neoplasms

Keywords

  • Endometrial cancer
  • Image-based brachytherapy
  • IMRT
  • PORTEC
  • Vagina recurrence

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Definitive salvage for vaginal recurrence of endometrial cancer : The impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification. / Vargo, John A.; Kim, Hayeon; Houser, Christopher J.; Berhane, Hebist; Sukumvanich, Paniti; Olawaiye, Alexander B.; Kelley, Joseph L.; Edwards, Robert P.; Comerci, John T.; Huang, Marilyn; Courtney-Brooks, Madeleine; Beriwal, Sushil.

In: Radiotherapy and Oncology, Vol. 113, No. 1, 2014, p. 126-131.

Research output: Contribution to journalArticle

Vargo, John A. ; Kim, Hayeon ; Houser, Christopher J. ; Berhane, Hebist ; Sukumvanich, Paniti ; Olawaiye, Alexander B. ; Kelley, Joseph L. ; Edwards, Robert P. ; Comerci, John T. ; Huang, Marilyn ; Courtney-Brooks, Madeleine ; Beriwal, Sushil. / Definitive salvage for vaginal recurrence of endometrial cancer : The impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification. In: Radiotherapy and Oncology. 2014 ; Vol. 113, No. 1. pp. 126-131.
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abstract = "Purpose: Data for salvage radiotherapy for recurrent endometrial cancer are limited especially in the era of modern radiotherapy including IMRT and 3-dimensional image-based HDR brachytherapy. Theoretically, modern radiotherapy reduces the dose to critical organs-at-risk and maximizes dose to the target volume, possibly decreasing morbidity and increasing tumor control. Materials and methods: Forty-one patients completing definitive salvage radiotherapy for vaginal recurrence of endometrial cancer from June 2004 to December 2013 were retrospectively reviewed. HDR Brachytherapy was completed using image-based planning with contouring/optimization with each fraction to a median dose of 23.75 Gy in 5 fractions. HDR brachytherapy was preceded by external beam radiotherapy predominately using an IMRT technique (90{\%}) to a median dose of 45 Gy in 25 fractions. Toxicity was reported according to CTCAEv4. Results: At a median follow-up of 18 months (range: 3-78), the clinical complete response rate was 95{\%}. The 3-year local control, distant control, recurrence free survival, and overall survival were 95{\%}, 61{\%}, 68{\%}, and 67{\%}. Significant predictors of both distant failure and overall survival were primary prognostic factors of depth of myometrial invasion, FIGO stage, and FIGO grade. There was no grade 3+ acute toxicity; the 3-year rate of grade 3+ late toxicity was 8{\%}. Conclusions: Salvage IMRT plus 3-dimensional image-based HDR brachytherapy shows excellent tumor control and minimal morbidity for vaginal recurrence of endometrial cancer. Anticipated salvage rates must be taken in the context of primary risk factors including depth of myometrial invasion, FIGO stage, and FIGO grade.",
keywords = "Endometrial cancer, Image-based brachytherapy, IMRT, PORTEC, Vagina recurrence",
author = "Vargo, {John A.} and Hayeon Kim and Houser, {Christopher J.} and Hebist Berhane and Paniti Sukumvanich and Olawaiye, {Alexander B.} and Kelley, {Joseph L.} and Edwards, {Robert P.} and Comerci, {John T.} and Marilyn Huang and Madeleine Courtney-Brooks and Sushil Beriwal",
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T1 - Definitive salvage for vaginal recurrence of endometrial cancer

T2 - The impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification

AU - Vargo, John A.

AU - Kim, Hayeon

AU - Houser, Christopher J.

AU - Berhane, Hebist

AU - Sukumvanich, Paniti

AU - Olawaiye, Alexander B.

AU - Kelley, Joseph L.

AU - Edwards, Robert P.

AU - Comerci, John T.

AU - Huang, Marilyn

AU - Courtney-Brooks, Madeleine

AU - Beriwal, Sushil

PY - 2014

Y1 - 2014

N2 - Purpose: Data for salvage radiotherapy for recurrent endometrial cancer are limited especially in the era of modern radiotherapy including IMRT and 3-dimensional image-based HDR brachytherapy. Theoretically, modern radiotherapy reduces the dose to critical organs-at-risk and maximizes dose to the target volume, possibly decreasing morbidity and increasing tumor control. Materials and methods: Forty-one patients completing definitive salvage radiotherapy for vaginal recurrence of endometrial cancer from June 2004 to December 2013 were retrospectively reviewed. HDR Brachytherapy was completed using image-based planning with contouring/optimization with each fraction to a median dose of 23.75 Gy in 5 fractions. HDR brachytherapy was preceded by external beam radiotherapy predominately using an IMRT technique (90%) to a median dose of 45 Gy in 25 fractions. Toxicity was reported according to CTCAEv4. Results: At a median follow-up of 18 months (range: 3-78), the clinical complete response rate was 95%. The 3-year local control, distant control, recurrence free survival, and overall survival were 95%, 61%, 68%, and 67%. Significant predictors of both distant failure and overall survival were primary prognostic factors of depth of myometrial invasion, FIGO stage, and FIGO grade. There was no grade 3+ acute toxicity; the 3-year rate of grade 3+ late toxicity was 8%. Conclusions: Salvage IMRT plus 3-dimensional image-based HDR brachytherapy shows excellent tumor control and minimal morbidity for vaginal recurrence of endometrial cancer. Anticipated salvage rates must be taken in the context of primary risk factors including depth of myometrial invasion, FIGO stage, and FIGO grade.

AB - Purpose: Data for salvage radiotherapy for recurrent endometrial cancer are limited especially in the era of modern radiotherapy including IMRT and 3-dimensional image-based HDR brachytherapy. Theoretically, modern radiotherapy reduces the dose to critical organs-at-risk and maximizes dose to the target volume, possibly decreasing morbidity and increasing tumor control. Materials and methods: Forty-one patients completing definitive salvage radiotherapy for vaginal recurrence of endometrial cancer from June 2004 to December 2013 were retrospectively reviewed. HDR Brachytherapy was completed using image-based planning with contouring/optimization with each fraction to a median dose of 23.75 Gy in 5 fractions. HDR brachytherapy was preceded by external beam radiotherapy predominately using an IMRT technique (90%) to a median dose of 45 Gy in 25 fractions. Toxicity was reported according to CTCAEv4. Results: At a median follow-up of 18 months (range: 3-78), the clinical complete response rate was 95%. The 3-year local control, distant control, recurrence free survival, and overall survival were 95%, 61%, 68%, and 67%. Significant predictors of both distant failure and overall survival were primary prognostic factors of depth of myometrial invasion, FIGO stage, and FIGO grade. There was no grade 3+ acute toxicity; the 3-year rate of grade 3+ late toxicity was 8%. Conclusions: Salvage IMRT plus 3-dimensional image-based HDR brachytherapy shows excellent tumor control and minimal morbidity for vaginal recurrence of endometrial cancer. Anticipated salvage rates must be taken in the context of primary risk factors including depth of myometrial invasion, FIGO stage, and FIGO grade.

KW - Endometrial cancer

KW - Image-based brachytherapy

KW - IMRT

KW - PORTEC

KW - Vagina recurrence

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