Comparative Results of Vaginal Relapses and Toxicity of Three 192-Ir HDR brachytherapy (BT) Schedules in Postoperative Endometrial Carcinoma (EC). Rovirosa.

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Comparative Results of Vaginal Relapses and Toxicity of Three 192-Ir HDR brachytherapy (BT) Schedules in Postoperative Endometrial Carcinoma (EC). Rovirosa A 1,2, Cortes KS I, Ascaso C 3, Herreros A 1, Sánchez J4, Arenas M5, Sabater S6, Rios I1,7, Sola J1, Agusti E1, Huguet J1, Garrido S1, Lloret A1, Castro C1, Escudero E1, Molina MD1, Arnau O1, Torne A2. 1- Radiation Oncology Dpt. and 2-Functional Gynecological Cancer Unit. Hospital Clinic, University of Barcelona. 3- Public Health Dpt. University of Barcelona. 4- Economics Dpt. Hospital Clinic Universitari, Barcelona. 5- Radiation Oncology Dpt. Hospital Sant Joan de Reus, Tarragona. 6- Radiation Oncology Dpt, Hospital General de Albacete, Albacete. SPAIN. 7- Radiation Oncology Dpt. Centro Imbanaco, Cali, Colombia INTRODUCTION RESULTS SUMMARY / CONCLUSION The best fractionation schedule is not established in Postoperative brachytherapy for endometrial carcinoma. Considering the results of the present analysis, treatment with 7Gy after EBI and 6Gy x 3 fractions daily in exclusive treatment was the best regime in postoperative EC. No differences were found in VCR and in vaginal, rectal and bladder toxicities between the 3 BT schedules. No vaginal relapses were found in patients receiving BT alone. Tables 2 and 3 show the characteristics and distribution of each group by stage, mean follow-up, (Mf-u), median overall BT treatment time (MBTT) and vaginal-cuff relapses (VCR). (Group 1&3: EBI+BT; Group 2&4: BT alone). The mean age of patients in schedule 1 was 66 years (38-89), 64 years (39-90) in schedule 2, and 66 years (39-90) in schedule 3. Table 4 show late toxicity results. VCR of the entire series 1.4%: 0% BT alone group and 2.0% in the EBI+BT group AIM To analyze the toxicity and vaginal control of three short brachytherapy (BT) schedules after surgery for endometrial carcinoma from 2003 to 2014. Table 2 (a,b and c). Table 2a:Group 1 (125p) Table 2b: Group 3 (94p) Table 2c: Group 3 (74p) Mean F-up (months) Stage Nºp MBTT (days) VCR 95 (11-153) IA * 29 5 (3-23) 1.7% 3p 2-IB, 1-IIIC1 IB * 61 II 12 IIIA 10 IIIB 2 IIIC1 9 IIIC2 2 Mean F-up (months) Stage Nºp MBTT (days) VCR nºp 67 (12-112) IA * 5 2 (2-12) 2.1% 2p (2-IB) IB * 45 II 14 IIIA 13 IIIB 2 IIIC1 10 IIIC2 5 Mean F-up (months) Stage Nºp MBTT (days) VCR 38 (10-67) IA * 13 1 0.9% 1p IB * 28 II 8 IIIA 4 IIIB 1 IIIC1 8 IIIC2 5 IV 7 MATERIAL & METHODS 421 patients with endometrial carcinoma (EC) staged after surgery as 2009-Figo I-IVB underwent radiotherapy from 2003 to 2014 using 3 different BT schedules. Table 1 shows patients (p) distributed into 4 groups (1 to 6) according to the number of patients, period of treatment and corresponding EBI+BT and BT alone schedules. * Presence of pathological type other than endometrioid, vascular and lymphatic space invasion and/or tumor size >3cm. Table 1: Schedule & period Number of p Treatment schedule f / w: Fraction/week. Schedule 1: 2003 to 2007 (166p) Group 1: 125p 4-6Gy in 3 f/w of after EBI Group 2: 41p 4-6Gy in 6 f/2w BT alone Schedule 2: 2007 to 2011 (153p) Group 3: 94p 5-6Gy in 2f/w after EBI Group 4: 59p 5-6Gy in 4f in BT alone Schedule 3; 2011 to 2014 (102p) Group 5: 74p Group 6: 28p 7Gy in 1 fr after EBI 6Gy x 3fr, daily in BT alone Table 3(a, b and c). Table 3a:Group 2 (41p) Table 3b: Group 4 (59p) Table 3c: Group 4 (28p) ACKNOWLEDGEMENTS Mean F-up (months) Stage Nºp MBTT (days) VCR 88 (16-143) IA 24 13 (8-28) IB 16 II 1 Mean F-up (months) Stage Nºp MBTT (days) VCR 75 (21-127) IA 33 6 (4-15) IB 24 II 2 Mean F-up (months) Stage Nºp MBTT (days) VCR 41 (11-73) IA 17 3 (3-5) IB 11 II 0 GRANT: SPANISH ASSOCIATION AGAINST CANCER (AECC) FOUNDATION Previous Surgery: Schedule 1: Vaginal hysterectomy + bilateral salpingo-oophorectomy and pelvic with or without paraaortic lymphadenectomy by laparoscopy: 37.8%; Abdominal hysterectomy + bilateral salpingo-oophorectomy and pelvic lymphadenectomy: 36.6%; Other: 25.5%. Schedule 2: Vaginal hysterectomy + bilateral salpingo-oophorectomy and pelvic with or without paraaortic lymphadenectomy by laparoscopy 42.5%; Abdominal hysterectomy + bilateral salpingo-oophorectomy and pelvic lymphadenectomy: 26.8%; Other: 30.7%. Schedule 3: Laparoscopic-assisted vaginal histerectomy plus bilateral oophorectomy (HBO) and pelvic plus para-aortica lymphadenectomy 32.3%, abdominal HBO and pelvic lymphadenectomy in 21.6%, vaginal HBO in 9.8%, abdominal HBO plus pelvic and para-aortic lymphadenectomy in 8 (7.8%) and ommentectomy in 7 (6.8%); Other:29.5%. Chemotherapy (CT). CT was administered in high risk and advanced cases when performance status and comorbidities allowed: 17p in schedule-1, 26p in schedule-2 and 20 in schedule-3 received 4-6 cycles of carboplatin and paclitaxel. Radiotherapy External beam irradiation (EBI) plus BT was considered for high risk and stages II-III p and BT alone for those with intermediate risk (but 3 stage II patients received exclusive BT). Two different BT schedules were used during this period of analysis. The mean EBI dose in Groups 1 and 3 was 44Gy (43.2-50.4). BT was performed mainly using vaginal cylinders in 309 p and colpostats in 10p. The median active length of BT treatment was 2.5cm (2-4). The mean and median cylinder size was 3.5cm. for the two BT schedules (2-3.5cm).10Ci HDR 192-Iridium source. Toxicity evaluation. Toxicity was prospectively evaluated using the RTOG score for the rectum and bladder and objective criteria of LENT-SOMA for the vagina. Statistical analysis. Chi-square and Fisher’s exact tests. . Table 4. Late toxicity in Organs at Risk LATE TOXICITY VAGINA BLADDER RECTUM GROUP-1 21.6% 9G1,16G2,1G3,1G4 1.6% 1G1,1G3 6.4% 5G1,2G2,1G3 GROUP-2 29.9% 8G1,4G2 2.4% 1G2 0% GROUP-3 28.7% 7G1,19G2,1G4 4.3% 1G1,1G2 8.5% 1G1,6G2,1G3 GROUP-4 33.9% 11G1,9G2 1.7% 1G1 GROUP-5 35.1% 5G1,21G2 2.7% 2G1 6.6% 3G1 GROUP-6 21.4% 3G1,2G2,1G3 P-VALUE 0.378 0.514 0.113 REFERENCES Rovirosa A, Ascaso C, Arenas M, et al. Can we shorten the overall treatment time in postoperative brachytherapy of endometrial carcinoma? Comparison of two brachytherapy schedules. Radiother Oncol 2015;116:143-148. Mitra D, Klopp AH, Viswanathan AN. Pros and cons of vaginal brachytherapy after external beamradiation therapy in endometrial cancer. Gynecol Oncol. 2016 140(1):167-75. Harkenrider MM, Block AM, Alektiar KM, et al. American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for earlys-stage endometrial cancer: A comprensive review. Brachytherapy. 2017; 16(1): 95-108. Small W, Beriwal S, Demanes J, et al. American brachytherapy society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy 2012;11:58-67. Contact information:s rovirosa@clinic.ub.es.