Radiation Oncology, University of California San Francisco (UCSF), San Francisco CA.
Gynecologic Oncology, The Permanente Medical Group, San Francisco CA.
Brachytherapy. 2021 May-Jun;20(3):536-542. doi: 10.1016/j.brachy.2020.12.011. Epub 2021 Feb 3.
Characterize the clinical outcomes of endometrial cancer vaginal recurrences after previous surgery and radiation therapy treated with reirradiation including image-guided interstitial high-dose-rate (HDR) brachytherapy.
A single-institution retrospective study identifying women receiving reirradiation for vaginal recurrence of endometrial cancer between 2004 and 2017.
Twenty-three women had vaginal recurrences of endometrial cancer, median 13.7 months (range 3.5-104.9) from initial radiation. All received reirradiation with interstitial HDR brachytherapy, and seven also received external beam radiation. Median reirradiation EQD2_10 was 48 Gy (range 24.0-68.81), and median cumulative EQD2_10 was 106.25 Gy (range 62.26-122.0). Median follow-up after reirradiation was 40.2 months (range 4.5-112.7). At 3 years, overall survival was 56%, cancer-specific survival was 61%, and disease-free survival was 46%. 14 patients experienced disease recurrence; 10 including distant sites, one at a regional node only. Three patients experienced local recurrences, two of whom did not complete the prescribed course of reirradiation. The overall crude local control rate was 87%. Three patients experienced Grade 3 vaginal toxicity. There was no bladder or rectal toxicity with Grade >2.
Reirradiation including interstitial HDR brachytherapy is a promising option for vaginal recurrences of endometrial cancer after prior radiation, with high rate of local control and acceptable toxicity. However, distant failure is common. Further studies are needed to determine cumulative radiation dose limits and the role of systemic therapy in this scenario.
描述既往手术和放疗后接受再放疗（包括图像引导的间质内高剂量率（HDR）近距离放疗）的子宫内膜癌阴道复发的临床结果。
本研究为单中心回顾性研究，纳入 2004 年至 2017 年间接受再放疗治疗的子宫内膜癌阴道复发的女性患者。
23 名女性患有子宫内膜癌阴道复发，从初始放疗开始的中位时间为 13.7 个月（范围 3.5-104.9）。所有患者均接受间质内 HDR 近距离放疗再放疗，7 例患者还接受外照射放疗。中位再放疗 EQD2_10 为 48Gy（范围 24.0-68.81），中位累积 EQD2_10 为 106.25Gy（范围 62.26-122.0）。再放疗后中位随访时间为 40.2 个月（范围 4.5-112.7）。3 年时，总生存率为 56%，癌症特异性生存率为 61%，无病生存率为 46%。14 例患者发生疾病复发；10 例包括远处部位，1 例仅为局部淋巴结。3 例患者出现局部复发，其中 2 例未完成规定的再放疗疗程。总体粗局部控制率为 87%。3 例患者出现 3 级阴道毒性。无膀胱或直肠毒性，无>2 级毒性。
包括间质内 HDR 近距离放疗在内的再放疗是既往放疗后子宫内膜癌阴道复发的一种有前途的选择，具有较高的局部控制率和可接受的毒性。然而，远处转移失败很常见。需要进一步的研究来确定累积辐射剂量限制以及在这种情况下系统治疗的作用。
