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Interstitial Brachytherapy Can Salvage Vaginal Recurrences of Endometrial Cancer: Presented at ESTRO

By Adrian Burton
Special to DG News

PRAGUE, CZECH REPUBLIC -- September 19, 2002 -- American researchers have found that interstitial brachytherapy can achieve complete control of vaginal recurrences of endometrial cancer.

Currently there are limited therapeutic options for patients who have a recurrence of endometrial cancer in the vaginal wall -- major surgery has many side effects, external beam radiation is associated with limited survival, and external beam plus intracavity radiation has resulted in limited success.

Normal intracavity irradiation might deliver incomplete doses because of tumour position, explained Dr. Subir Nag, a professor of radiology at Ohio State University, in Columbus, Ohio, speaking here today at the 21^st annual meeting of the European Society for Therapeutic and Radiation Oncology (ESTRO). "Usually these types of tumour are situated at the top of the vaginal cavity where it is difficult to deliver a full dose with normal intracavity methods."

With the new technique, he added, "what we have done is to put needles directly into the tumour, and therefore deliver a full dose of radiation right where it is needed. By doing so we give a much higher dose to the tumour itself, but less to the vaginal mucosa."

Between September 1989 and September 2000, Dr. Nag's team enrolled 13 previously unirradiated patients (mean age 70 years) with vaginal recurrences of endometrial adenocarcinoma and treated them by brachytherapy. The small number of patients enrolled in the study is owed to the fact that this is not a common type of cancer, he explained.

Eleven patients received a total of 45-50 Gy pelvic external radiation plus a mean boost of 28.3 Gy (range 18 - 35 Gy) by brachytherapy. The remaining two patients received only brachytherapy (40 or 50 Gy). Brachytherapy was delivered using a modified perineal Syed template loaded with either 192Ir (n=12) or 137Cs (n=1). After suturing into place, the brachytherapy source was left for two days. Mean tumour size was 2.2 cm (range 1.5 - 6 cm); 10 were situated at the vaginal apex, three on the vaginal wall.

Although three patients relapsed with metastases at distant points, all patients showed complete local control at five years. At eight years, disease specific survival was 77 percent.

"Local control of 100 percent is very unusual," explained Dr. Nag, "especially at five years. And if we take into account that survival rate at eight years was 77 percent, we are almost talking about curative therapy. With this system we also see less damage caused to the bladder and rectum. Technically, this treatment is more difficult [to perform] than standard intracavity treatment, but if people learn how to do it we might see much better results for this problem," Dr. Nag concluded.

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