[The results of primary HDR-afterloading brachytherapy in corpus carcinoma].

PURPOSE

In general the results of radiotherapy are regarded to be inferior compared to those of surgery, when it comes to the treatment of endometrial carcinoma, but some patients are elderly and have multiple medical problems, which make them inoperable. The risk of intracavitary radium therapy, caused by immobilisation, can be reduced by the use of fractionated high-dose-rate afterloading brachytherapy. With this method there are only very few results reported.

PATIENTS AND METHODS

Treatment results of HDR brachytherapy (4 to 5 times 8.5 Gy, one-channel applicator, intracavitary and 1 to 2 times 7 Gy intravaginal) at the University Hospital Vienna were analysed retrospectively (actuarial method [Kaplan-Meier]) regarding overall survival and recurrence-free interval according to stage and histology. Over a period from April 1981 until December 1992 325 patients were treated by this technique alone or combined with external beam therapy. Two hundred and eighty patients could be evaluated. Staging based on clinical examination and fractionated curettage.

RESULTS

Five-year overall survival was 58.1%, in stage Ia 68.5%, stage Ib 49.9%, stage II 48.7%, according to histopathologic grading 1 68.5%, grade 2 53.2%, grade 3 37.5%. 64 patients developed a recurrence after a median of 13 months, 45 of those a local recurrence only, 6 a local recurrence with distant metastases, 6 a lymph node recurrence only and 7 patients distant metastases only.

CONCLUSION

These results are at least comparable to those of intracavitary radium therapy and low-dose-rate afterloading techniques. Better local control rates should be obtained by the Heyman packing method using Norman-Simon applicators based on individualised brachytherapy treatment planning, which optimises dose distribution according to the target volume based on computerised imaging.