Session Item

Analyse the outcomes of stage I-III inoperable endometrial cancer (EC) patients treated with 3D-image-guided brachytherapy (IGBT) and external beam irradiation (EBRT) hypothesising that this treatment provides good results.

Medical records of EC patients treated in 8 European centres and one from Canada from 2003-2019 with EBRT + IGBT were examined, including:  EBRT pelvic +/- paraaortic and lymph node boost doses; anaesthetic procedure, applicator type, BT-planning imaging, clinical target volume (CTV), BT schedule, overall daily dose equivalent to 2Gy fractions (EQD2_{(α/β=4,5 or 3)}) to the CTV_(α/β=4,5) and D_{2cm3(α/β=3)} for organs at risk. Complications were evaluated using CTCAEv4 scores. Survival probability by stages at 2 and 5 years was estimated (cancer-specific survival [CSS], disease-free survival [DFS], local relapse-free survival [LRFS], loco-regional relapse-free survival [LRRFS] and distant metastasis-free survival [DMFS]). Statistics: Survival analysis included descriptive analysis and the Kaplan-Meier method. 

103 patients staged I (44), II (14) and III (44) were included. Median follow-up: 38 months (6-170). All patients received pelvic +/- para-aortic EBRT and nodal boost when necessary. General anaesthesia (43%) followed by spinal anaesthesia (18%) were most common. Y-Shaped Rotte was the most common (24%) followed by tandem + mould (21%). The median D90 EQD2_(α/β=4.5) to the CTV was 73.3 (44.6-132.7) in stage I, 69.9 (15-87.9) in Stage II and 75.2 (55.1-97) in stage III.                        

Thirty-four patients presented relapse: uterine in 24 (7 in Stage 1, 3 in II and 14 in stage III), nodal in 15 and distant in 23 (most common in stage III). Six of eight patients with uterine tumour relapse/persistence alone were rescued by surgery and they are alive at present. At 2 and 5 years, CSS was 88.7% and 71.2%, (stages I, II and III were 92.4% and 82.6%, 90.9% and 79.5%, 84.6% and 56.7%, respectively), DFS 71.7% and 55.5%, LRFS was 75.6% and 59%, LRRFS was 75.7% and 59.1% and DMFS was 81.3% and 64.4% respectively. Late G3-G4 complications appeared in 1% in the small bowel, 2% in rectum and 3% in bladder.  

In stages I-III inoperable EC IGBT + EBRT offers good CSS results of 88.7% and 71.2% at 2 and 5 years, respectively with the best outcome in stages I and II. 3D-IGBT provides effective treatment for inoperable patients and prospective studies should help to determine how to obtain better outcomes.