Salvage treatment with high-dose-rate brachytherapy for isolated vaginal endometrial cancer recurrence

Objective.To evaluate the outcome of patients with recurrent vaginal endometrial cancer treated with high-dose-rate brachytherapy (HDRB) and external beam radiation therapy (EBRT).Materials and methods.The records of all patients diagnosed with endometrial cancer who had presented an isolated vaginal recurrence in our institution between January 1, 1997 and December 30, 2003 were reviewed. Twenty-two patients were identified; 18 (82%) received both EBRT and HDRB, and 4 (18%) received HDRB only. The median EBRT dose prescribed was 45 Gy (range: 44–50.4), and median HDRB was 26 Gy (range: 8–48). Recurrence-free intervals as well as disease-specific survival rates were noted. Complications were assessed in terms of early and late Radiation Therapy Oncology Group toxicity (grade 3 or worse) of the gastrointestinal tract, genitourinary tract and vagina.Results.Median age at recurrence for the 22 patients was 72 years (range: 54–86). Median recurrence time was 20 months (range: 4–135). A complete response was achieved in 100% of patients. After a median follow-up of 32 months (range: 11–78), no patient had locoregional recurrence; 1 developed distant metastasis and died from the disease. Five-year local control, disease-free survival and disease-specific survival were 100%, 96% and 96%, respectively. Four patients (18%) presented grades 3–4 gastrointestinal toxicity, and 11 (50%), grade 3 vaginal toxicity.Conclusion.Recurrent vaginal endometrial cancer is amenable to salvage therapy with HDRB and EBRT.