17 Endometrial Cancer

Endometrial Cancer

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II: Clinical Practice Version 1 - 25/04/2016

13.2 Definitive radiotherapy with the uterus in situ Brachytherapy alone Patients who have brachytherapy alone are often high risk patients with serious comorbidities. In this setting acute toxic- ity may be dominated by cardiovascular and thromboembolic complications of the procedure rather than radiation effects themselves. Severe acute side effects are not expected but grade 1 and 2 urinary toxicity may be seen in around 40% [74]. The incidence of grade 3 or more late effects varies reflecting the retrospective nature and small number of patients in most se- ries between <5% and 38% [73,74]. This reflects predominantly grade 1 and 2 vaginal dryness or shrinkage and urinary urgency. More severe complications are rare but both proctitis and rectal bleeding and haematuria are reported and vesicovaginal fistula has been described.

External beam in combination with brachytherapy The incidence of late complications after definitive brachy­ therapy for uterine cancer is reported variously between 2% to 17.5%. In the series fromNancy using LDR brachytherapy, grade 1 complications were reported in 10% of the patients, grade 2 in 4.3%, grade 3 in 3% and grade 4 in 1.4% [58]. The complications were mostly located in the rectosigmoid. The complication rate has decreased significantly with the use of new techniques and computerized dosimetry. Similar experience has been reported after HDR brachytherapy. The overall actuarial rate of side effects was 24% grade I, 5.7% grade II, and 5.2% grade III/IV. For the different organs, the actuarial rate of grade III/IV side effects were bladder 0.9%, rectum 0.4%, vulvovagina 0.8% and bowel 3.5% [75]. With the systematic use of 3 D image based treatment planning and the Heymann packing method in Vienna, the rate of side effects has been was significantly reduced in the last decade [74].

14. KEY MESSAGES

• Vaginal vault brachytherapy is indicated post-hysterectomy for intermediate risk endometrial cancer.

• Vaginal vault brachytherapy is indicated post-hysterectomy for high risk endometrial cancer in combination with external beam therapy when there has been cervial involvement

• Vaginal vault brachytherapy reduces local recurrence but may have no effect upon survival

• Vaginal vault brachytherapy has a low toxicity profile, the most common late effect being vaginal dryness and stenosis.

• Intrauterine brachytherapy using capsules or a Y applicator is indicated for stage I or II endometrial cancer in patients unfit for hysterectomy. • Intrauterine brachytherapy using capsules or a Y applicator is indicated with external beam therapy in stage III endometrial cancer.