18. Primary vaginal cancer and vaginal recurrences - The GEC-ESTRO Handbook of Brachytherapy

Primary vaginal cancer and vaginal recurrences

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 01/09/2023

14. KEY MESSAGES

• Brachytherapy plays a key role in the treatment of vaginal tumours; • State of the art brachytherapy treatment for vaginal tumours is according to the GEC-ESTRO/ACROP and GEC-ESTRO (ACROP)–ABS–CBG guidelines based on 3D volumetric image-guided adaptive brachytherapy (IGABT) preferably with the use of MRI imaging; • It is recommended to treat vaginal tumours with a residual thickness perpendicular to the vaginal wall of more than 5-7 mm at brachytherapy with an intracavitary and interstitial approach; • Treatment with 3D-based image-guided brachytherapy in vaginal tumours including combined IC/IS techniques leads to better local control compared to radiograph-based brachytherapy, especially in larger tumours; • A total D90 dose in the CTV-T HR of 75-85 Gy in EQD2 αβ10 is aimed for dependent on location, histological type and volume of the tumour; • There is a trend of a dose-effect relationship, with better local control with doses higher than 80 Gy D90 prescribed to the CTV-T HR in patients treated for large (≥ T2) primary vaginal cancer. • A substantial number of patients treated for vaginal tumours suffer from severe late effects, and in particular from vaginal and urinary symptoms.