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• W2007799478 abstract "The adjuvant management of stage III Endometrial Cancer continues to evolve in a multidisciplinary fashion. There remains controversy and practice pattern variation regarding the patient selection, rationale, and benefit of a vaginal brachytherapy boost after consolidative adjuvant pelvic radiation therapy. We evaluated clinical prognostic factors and the impact of a vaginal brachytherapy boost on vaginal and pelvic control of stage III patients treated at our institution. We examined medical records of patients treated consecutively from 1998 to 2011 with stage 3A-3C endometrial cancer. Patients were treated with TAH/BSO and adjuvant therapy consisting of chemotherapy and/or pelvic external beam radiation therapy with or without a vaginal brachytherapy boost. Assessed variables include performance status, tumor grade, pathologic T stage, N stage, lymphovascular space invasion (LVSI), vaginal involvement (VI), lower uterine segment invasion, cervical stromal involvement (CSI), myometrial invasion (MI) and use of vaginal brachytherapy (VB). Failure was scored as vaginal, pelvic, abdominal or distant. Fisher's Exact test was used to assess the impact of these variables on disease control. There were 100 patients identified with a median follow-up of 43 months, average age of 61 years old with a median KPS of 90%. Thirty-one percent of patients had pathologically identified CSI and average depth of MI was 68%. Seventy-eight patients had adenocarcinoma, 11 had papillary serous carcinoma, 7 had carcinosarcoma and 4 had clear cell carcinoma. Thirty-one percent were stage 3A, 6% stage 3B, and 63% stage 3C with an average of 3 positive lymph nodes and 57% with LVSI. Thirty-eight percent received pelvic radiation therapy alone, 62% received adjuvant chemotherapy and consolidative pelvic radiation and 89% were treated with VB. Of the 82 patients who received VB, a total of 5 failed in the vagina with vaginal and pelvic control rates of 94% and 92%. In patients not boosted, the vaginal and pelvic control rates were 90% and 70%. The impact of VB reached borderline significance with its impact on pelvic control, 92% vs 70% (p = 0.055). Vaginal control with and without VB was 94% and 90% (p = 0.50). Tumor grade (p = 0.76), LVSI (p = 1.00), CSI (p = 0.37), stage (p = 0.76), lower uterine segment invasion (p = 0.39) nor VI (p = 0.40) was found to have a statistical impact on vaginal control. Stage III endometrial cancer patients treated with consolidative pelvic radiation and a vaginal brachytherapy boost had excellent pelvic and vaginal control. The presence of high grade, vaginal, lymphovascular or cervical involvement did not adversely affect outcomes in our patient cohort suggesting a beneficial role of brachytherapy in this population." @default.
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• W2007799478 date "2013-10-01" @default.
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• W2007799478 title "Stage III Endometrial Cancer Treated With Consolidative Pelvic Radiation: The Impact of Additional Dose With Vaginal Brachytherapy" @default.
• W2007799478 doi "https://doi.org/10.1016/j.ijrobp.2013.06.1105" @default.
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