Does Brachytherapy Improve Survival in Addition to External Beam Radiation Therapy in Patients With High Risk Stage I and II Endometrial Carcinoma?

2010 ◽  
Vol 33 (4) ◽  
pp. 364-369 ◽  
Author(s):  
Marcus A. Crosby ◽  
Jonathan D. Tward ◽  
Aniko Szabo ◽  
Christopher M. Lee ◽  
David K. Gaffney
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Endometrial Carcinoma ◽  
External Beam Radiation Therapy ◽  
Stage I ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

Impact of different adjuvant radiotherapy modalities on women with early-stage intermediate- to high-risk endometrial cancer

2019 ◽  
Vol 29 (8) ◽  
pp. 1264-1270
Author(s):  
Meng Jin ◽  
Xiaorong Hou ◽  
Xiansun Sun ◽  
Yuelun Zhang ◽  
Ke Hu ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Cancer ◽  
High Risk ◽  
Early Stage ◽  
External Beam Radiation Therapy ◽  
Stage I ◽  
External Beam Radiation ◽  
Survival Outcomes ◽  
External Beam ◽  
Beam Radiation

ObjectiveVaginal brachytherapy was recommended for patients with intermediate-risk endometrial cancer, however, optimal radiotherapy modalities for intermediate-high- or high-risk patients remains controversial. Previous studies have mainly focused on survival outcomes and have seldom taken cost issues into consideration, especially for high-risk patients. The purpose of this study is to compare the survival outcomes and costs associated with two adjuvant radiotherapy modalities in the management of patients with early-stage, intermediate- to high-risk endometrial cancer.MethodsAccording to ESMO-ESCO-ESTRO criteria, 238 patients with stage I/II, intermediate- to high-risk endometrial cancer who underwent radiotherapy from January 2003 to December 2015 at our institution were reviewed. The vaginal brachytherapy group and external beam radiation therapy combined with the vaginal brachytherapy group were propensity score-matched at a 1:1 ratio. The Kaplan–Meier method and Cox proportional hazards regression model were used.ResultsA total of 361 patients met our inclusion criteria, the median age of the patients was 58 years (range, 28–85). All were diagnosed with stage I–II endometrial cancer (324 with stage I and 37 with stage II; 350 with endometrioid adenocarcinoma; and 10 with mucinous carcinoma). The median follow-up time was 60.5 months (range, 3–177). Among 119 matched pairs, no significant differences were found in overall (10.9% vs 8.4%, P=0.51), locoregional (4.2% vs 1.7%, P=0.45), or distant recurrence rates (6.7% vs 6.7%, P=1.0) between the two groups. There were also no differences in the 5-year overall (94.8% vs 93.9%, P=0.78) or progression-free survival (90.0% vs 84.4%, P=0.23) between the two groups. The rates of acute and late toxicity were significantly higher in the external beam radiation therapy combined with vaginal brachytherapy vs the vaginal brachytherapy group (all P<0.05), except for the acute hematological toxicity rate (17.6% vs 9.2%, P=0.06). External beam radiation therapy combined with vaginal brachytherapy had a higher median cost ($2759 vs $937, P<0.001) and longer median radiotherapy duration (41 days vs 17 days, P<0.001) than vaginal brachytherapy.ConclusionVaginal brachytherapy was associated with similar local control and long-term survival outcomes relative to the combination of external beam radiotherapy and vaginal brachytherapy and it also minimizes radiation-related complications, reduces medical costs, and shortens radiotherapy duration. Vaginal brachytherapy may be the optimal radiation modality for patients with early-stage endometrial cancer at intermediate to high risk.

Impact of vaginal brachytherapy on survival in stage I endometrioid endometrial carcinoma

2020 ◽  
Vol 30 (6) ◽  
pp. 789-796 ◽  
Author(s):  
Mariam AlHilli ◽  
Sudha Amarnath ◽  
Paul Elson ◽  
Lisa Rybicki ◽  
Sean Dowdy
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
External Beam Radiation Therapy ◽  
Stage I ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Stage Ib ◽  
Stage Ia

ObjectiveTo evaluate trends in use of radiation therapy and its impact on overall survival in low- and high-grade stage I endometrioid endometrial carcinoma.MethodsPatients with stage I endometrial cancer who underwent hysterectomy from 2004 to 2013 were identified through the National Cancer Database and classified as: stage IA G1/2, stage IA G3, stage IB G1/2, and stage IB G3. Trends in use of vaginal brachytherapy and external beam radiation therapy were assessed. Overall survival was measured from surgery and estimated using the Kaplan-Meier method. The effect of radiation therapy on overall survival was assessed within each stage/grade group using Cox proportional hazards analysis in propensity-matched treatment groups.ResultsA total of 132 393 patients met inclusion criteria, and 81% of patients had stage IA and 19% had stage IB endometrial cancer. Adjuvant therapy was administered in 18% of patients: 52% received vaginal brachytherapy, 30% external beam radiation therapy, and 18% chemotherapy ±radiation therapy. External beam radiation therapy use decreased from 9% in 2004 to 4% in 2012, while vaginal brachytherapy use increased from 8% to 14%. Stage IA G1/2 patients did not benefit from either external beam radiation therapy or vaginal brachytherapy, while administration of vaginal brachytherapy improved overall survival in stage IB G1/2 compared with no treatment (p<0.0001). In stage IB G1/2 and stage IA G3, vaginal brachytherapy was superior to external beam radiation therapy (p=0.0004 and p=0.004, respectively). Stage IB G3 patients had improved overall survival with either vaginal brachytherapy or external beam radiation therapy versus no treatment but no difference in overall survival was seen between vaginal brachytherapy and external beam radiation therapy (p=0.94).ConclusionsThe delivery of adjuvant radiation therapy in patients with stage IA G1/2 endometrial carcinoma is not associated with improvement in overall survival. Patients with stage IB G1/2 and G3 as well as stage IA G3 are shown to benefit from improved overall survival when adjuvant radiation therapy is administered. These findings demonstrate potential opportunities to reduce both overtreatment and undertreatment in stage I endometrial cancer patients.

Do Not Count Out External-Beam Radiation Therapy for High-Risk Prostate Cancer

2010 ◽  
Vol 28 (28) ◽  
pp. e518-e519 ◽  
Author(s):  
Daniel A. Hamstra ◽  
Jeff M. Michalski ◽  
Mack Roach ◽  
Howard M. Sandler
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer
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