阴道袖带近距离放射治疗子宫内膜癌具有低毒性

Introduction: Vaginal cuff brachytherapy administered in multiple doses to patients with early-stage endometrial cancer has low toxicity and a low recurrence rate, with a 5-year local recurrence rate of 5%.

Brachytherapy is a method of treating tumors by placing the radioactive source in the natural cavity of the human body (such as the nasopharynx, esophagus, vagina, uterine cavity, rectum, etc.) or between tissues. The closer to the radioactive source, the stronger the intensity of the radiation.

No patients experienced grade 3 or higher acute or chronic toxicities, and grade 2 toxicities were rarely reported. The most common grade 1 acute toxicities included fatigue (11%), urinary frequency (11%), chronic urinary frequency (13%), urinary incontinence (13%), and vaginal stenosis (21%). The most common grade 2 acute toxicities included urinary incontinence (3%) and vaginal dryness (2%).

The most common grade 1 chronic toxicities included: urinary frequency (13%), urinary incontinence (13%), and vaginal stenosis (21%). The most common grade 2 chronic toxicities included vaginal dryness (4%), urinary incontinence (3%), and vaginal stenosis (3%).

The 5-year local recurrence rate is 5%, the regional recurrence rate is 5%, and the distant metastasis rate is 7%. The 5-year overall survival rate was 91% and the disease-free survival rate was 83%.

From 1992 to 2018, a total of 247 patients were recruited and treated. The majority of patients had early-stage disease, with 52% stage IA, 37% stage IB, and 11% stage II. The patient's treatment depth was 5 mm. The study's median follow-up time was 5.8 years. The researchers said that 80% of patients received high-dose-rate VBT alone, and 20% also received adjuvant chemotherapy. Adjuvant therapy consisted of 6 cycles of carboplatin and paclitaxel.

Of the 48 patients (out of 50) who received chemotherapy, 10% had stage II disease, 72% had high-risk histology, 38% had lymphovascular space spread, and 22% had grade 3 disease and deep myometrial spread.

The study also included 79 patients with stage II disease (10%) or high-risk disease (21%).

Eleven patients had local recurrence, and the recurrence time was 1.4 years. In addition, 9 patients had recurrence within the radiotherapy area and 2 had recurrence outside the distal vaginal area. During initial VBT treatment, the target is 4 cm proximal to the vagina. A total of 7 patients had isolated local recurrence and were rescued, of which 5 were still alive and 2 died from other causes. A total of 3 patients died due to disease progression, and 1 patient survived without disease progression.

Important predictors of local recurrence include: depth of myometrial invasion, tumor stage, and overall FIGO stage. The 5-year local recurrence rate was 8.4% for high-risk/intermediate-risk patients, 2.4% for high-risk patients, and 4.4% for stage II patients.

References:

https://www.cancernetwork.com/view/vaginal-cuff-brachytherapy-for-endometrial-cancer-yields-low-toxicity