Skip to main content

Gynecologic Brachytherapy: Endometrial Cancer

  • Chapter
  • First Online:
Brachytherapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

  • 1317 Accesses

Abstract

The management of endometrial cancer generally involves surgical extirpation of tumor as a primary therapeutic endeavor. Following surgery, and in some cases in lieu of surgery (in medically inoperable patients), brachytherapy is frequently required as part of the definitive treatment scheme. We present management guidelines and techniques in this chapter to aid in the therapeutic management of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30

    Article  PubMed  Google Scholar 

  2. Small W, Beriwal S, Demanes DJ et al (2012) American brachytherapy society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy 11:58–67

    Article  PubMed  Google Scholar 

  3. Creutzberg CL, Van Putten WL, Koper PC et al (2003) Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 89:201–209

    Article  PubMed  Google Scholar 

  4. Jhingran A, Burke TW, Eifel PJ (2003) Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys 56:1366–1372

    Article  PubMed  Google Scholar 

  5. Morrow CP, Bundy BN, Kurman RJ et al (1991) Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group Study. Gynecol Oncol 40:55–65

    Article  CAS  PubMed  Google Scholar 

  6. Keys HM, Roberts JA, Brunetto VL et al (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 92:744–751

    Article  PubMed  Google Scholar 

  7. Nout RA, Van de Poll-Franse LV, Lybeert ML et al (2011) Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post-operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol 29:1692–1700

    Article  PubMed  Google Scholar 

  8. Nout RA, Smit VT, Putter H et al (2010) Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomized trial. Lancet 375:816–823

    Article  CAS  PubMed  Google Scholar 

  9. NCCN clinical practice guidelines in oncology (NCCN Guidelines®) uterine neoplasms version 1 2015 (Nov 2014). Available at www.nccn.org

  10. Klopp A, Smith BD, Alektiar K et al (2014) The role of postoperative radiation therapy for endometrial cancer: executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol 4:137–144

    Article  PubMed  Google Scholar 

  11. Cattaneo R, Hanna RK, Jacobsen G et al (2014) Interval between hysterectomy and start of radiation treatment is predictive of recurrence in patients with endometrial carcinoma. Int J Radiat Oncol Biol Phys 88:866–871

    Article  PubMed  Google Scholar 

  12. Small W, Erickson B, Kwakwa F (2005) American Brachytherapy Society survey regarding practice patterns of postoperative irradiation for endometrial cancer: current status of vaginal brachytherapy. Int J Radiat Oncol Biol Phys 63:1502–1507

    Article  PubMed  Google Scholar 

  13. Demanes DJ, Rege S, Rodriguez RR et al (1999) The use and advantages of a multichannel vaginal cylinder in high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 44:211–219

    Article  CAS  PubMed  Google Scholar 

  14. Peng J, Sinha R, Patel R, Lebovic G (2011) A comparison of 3D dose planning regimens for vaginal cuff brachytherapy using a flexible inflatable multichannel gynecologic applicator. Brachytherapy 10:S67

    Article  Google Scholar 

  15. El Khoury C, Dumas I, Tailleur A et al (2015) Adjuvant brachytherapy for endometrial cancer: advantaged of the vaginal mold technique. Brachytherapy 14:51–55

    Article  PubMed  Google Scholar 

  16. Tuncell N, Toy A, Demiral AN, Cetingoz R et al (2009) Dosimetric comparison of ring and ovoid applicators. J Buon 14:451–454

    CAS  PubMed  Google Scholar 

  17. Stewart AJ, Cormack RA, Lee H et al (2008) Prospective clinical trial of bladder filling and tree-dimensional dosimetry in high-dose-rate vaginal cuff brachytherapy. Int J Radiat Oncol Biol Phys 72:843–848

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hung J, Shen S, De Los Santos JF et al (2012) Image-based 3D treatment planning for vaginal cylinder brachytherapy: dosimetric effects of bladder filling on organs at risk. Int J Radiat Oncol Biol Phys 83:980–985

    Article  PubMed  Google Scholar 

  19. Kim H, Kim H, Houser C et al (2012) Is there any advantage to three-dimensional planning for vaginal cuff brachytherapy? Brachytherapy 11:398–401

    Article  PubMed  Google Scholar 

  20. Zhou J, Prisiandaro J, Lee C et al (2014) Single or multi-channel vaginal cuff high-dose-rate brachytherapy: is replanning necessary prior to each fraction? Pract Radiat Oncol 4:20–26

    Article  PubMed  Google Scholar 

  21. Townamchai K, Lee L, Viswanathan AN (2012) A novel low dose fractionation regimen for adjuvant vaginal brachytherapy in early stage endometrial cancer. Gynecol Oncol 127:351–355

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sorbe B, Staumtis A, Karlsson L (2005) Intravaginal high-dose brachytherapy for stage I endometrial cancer: a randomized study of two dose-per-fraction levels. Int J Radiat Oncol Biol Phys 62:1385–1389

    Article  PubMed  Google Scholar 

  23. Viswanathan AN, Creutzberg CL, Craighead P et al (2012) International brachytherapy practice patterns: a survey of the Gynecologic Cancer Intergroup (GCIG). Int J Radiat Oncol Biol Phys 82:250–255

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fraass B, Doppke M, Hunt M et al (1998) American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: quality assurance for clinical radiotherapy treatment planning. Med Phys 25:1773–1829

    Article  CAS  PubMed  Google Scholar 

  25. Glasgow GP, Bourland JD, Grigsby PW et al (1993) Remote afterloading technology: a report of AAPM Task Group No. 41. American Institute of Physics, New York

    Google Scholar 

  26. Kubo HD, Glasgow GP, Pethel TD et al (1998) High dose-rate brachytherapy treatment delivery: a report of the AAPM Radiation Therapy Committee Task Group No. 59. Med Phys 25:375–403

    Article  CAS  PubMed  Google Scholar 

  27. Nath R, Anderson LL, Meli JA et al (1997) Code of practice for brachytherapy physics: report of the AAPM Radiation Therapy Committee Task Group No. 56. Med Phys 24:1557–1598

    Article  CAS  PubMed  Google Scholar 

  28. Sorbe B, Nordstrom B, Maenpaa J et al (2009) Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer 19:873–878

    Article  PubMed  Google Scholar 

  29. Sorbe BG, Smeds AC (1990) Postoperative vaginal irradiation with high dose rate afterloading technique in endometrial carcinoma stage I. Int J Radiat Oncol Biol 18:305–314

    Article  CAS  Google Scholar 

  30. MacLeod C, Fowler A, Duval P et al (1998) High-dose-rate brachytherapy alone post-hysterectomy for endometrial cancer. Int J Radiat Oncol Biol 42:1033–1039

    Article  CAS  Google Scholar 

  31. Weiss E, Hirnle P, Arnold-Bofinger H et al (1998) Adjuvant vaginal high-dose-rate afterloading alone in endometrial carcinoma: patterns of relapse and side effects following low-dose therapy. Gynecol Oncol 71:72–76

    Article  CAS  PubMed  Google Scholar 

  32. Anderson JM, Stea B, Hallum AV et al (2000) High-dose-rate postoperative vaginal cuff irradiation alone for stage IB and IC endometrial cancer. Int J Radiat Oncol Biol Phys 46:417–425

    Article  CAS  PubMed  Google Scholar 

  33. Horowitz NS, Peters WA, Smith MR et al (2002) Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma. Obstet Gynecol 99:235–240

    PubMed  Google Scholar 

  34. Alektiar KM, Venkatraman E, Chi DS, Barakat RR (2005) Intravaginal brachytherapy alone for intermediate-risk endometrial cancer. Int J Radiat Oncol Biol Phys 62:111–117

    Article  PubMed  Google Scholar 

  35. Greven KM, D’Agostino RB, Lanciano RM et al (1998) Is there a role for a brachytherapy vaginal cuff boost in the adjuvant management of patients with uterine-confined endometrial cancer? Int J Radiat Oncol Biol Phys 42:101–104

    Article  CAS  PubMed  Google Scholar 

  36. Kucera H, Vavra N, Weghaupt K (1990) Benefit of external irradiation in pathologic stage I endometrial carcinoma: a prospective clinical trial of 605 patients who received post-operative vaginal irradiation and additional pelvic irradiation in the presence of unfavorable prognostic factors. Gynecol Oncol 38:99–104

    Article  CAS  PubMed  Google Scholar 

  37. Lybeert ML, van Putten WL, Ribot JG et al (1989) Endometrial carcinoma: high dose rate brachytherapy in combination with external irradiation: a multivariate analysis of relapse. Radiother Oncol 16:245–252

    Article  CAS  PubMed  Google Scholar 

  38. Aalders J, Abeler V, Kolstad P et al (1980) Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol 56:419–427

    CAS  PubMed  Google Scholar 

  39. Bruner DW, Lanciano R, Keegan M et al (1993) Vaginal stenosis and sexual function following intracavitary radiation for the treatment of cervical and endometrial carcinoma. Int J Radiat Oncol Biol Phys 27:825–830

    Article  CAS  PubMed  Google Scholar 

  40. Nout RA, Putter H, Jurgenliemk-Schultz IM et al (2009) Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol 27:3547–3556

    Article  PubMed  Google Scholar 

  41. Decruze SB, Guthrie D, Magnani R (1999) Prevention of vaginal stenosis in patients following vaginal brachytherapy. Clin Oncol (R Coll Radiol) 11:46–48

    Article  CAS  Google Scholar 

  42. Friedman LC, Abdallah R, Schluchter M et al (2011) Adherence to vaginal dilation following high doe rate brachytherapy for endometrial cancer. Int J Radiat Oncol Biol Phys 80:751–757

    Article  PubMed  Google Scholar 

  43. Lancaster L (2004) Preventing vaginal stenosis after brachytherapy for gynecological cancer: an overview of Australian practices. Eur J Oncol Nurs 8:30–39

    Article  PubMed  Google Scholar 

  44. Coon D, Beriwal S, Heron DE et al (2008) High-dose-rate Rotte “Y” applicator brachytherapy for definitive treatment of medically inoperable endometrial cancer: 10-year results. Int J Radiat Oncol Biol Phys 71:779–783

    Article  PubMed  Google Scholar 

  45. Fishman DA, Roberts KB, Chambers JT et al (1996) Radiation therapy as exclusive treatment for medically inoperable patients with stage I and II endometrioid carcinoma with endometrium. Gynecol Oncol 61:189–196

    Article  CAS  PubMed  Google Scholar 

  46. Nguyen TV, Petereit DG (1998) High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer. Gynecol Oncol 71:196–203

    Article  CAS  PubMed  Google Scholar 

  47. Rouanet P, Dubois JB, Gely S, Pourquier H (1993) Exclusive radiation therapy in endometrial carcinoma. Int J Radiat Oncol Biol Phys 26:223–228

    Article  CAS  PubMed  Google Scholar 

  48. Podzielinski I, Randall ME, Breheny PJ et al (2012) Primary radiation therapy for medically inoperable patients with clinical stage I and II endometrial carcinoma. Gynecol Oncol 124:36–41

    Article  PubMed  Google Scholar 

  49. Cunha TM, Felix A, Cabral I (2001) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and gross visual inspection. Int J Gynecol Cancer 11:130–136

    Article  CAS  PubMed  Google Scholar 

  50. Frei KA, Kinkel K, Bonel HM et al (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging a meta-analysis and Bayesian analysis. Radiology 216:444–449

    Article  CAS  PubMed  Google Scholar 

  51. Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718

    Article  CAS  PubMed  Google Scholar 

  52. Johnson SB, Zhou J, Jolly S et al (2014) The dosimetric impact of single, dual, and triple tandem applicators in the treatment of intact uterine cancer. Brachytherapy 13:268–274

    Article  PubMed  Google Scholar 

  53. Herbolsheimer M, Sauer O, Rotte K (1992) Primary irradiation of endometrial cancer: technical aspects, individual treatment planning, and first results in a modified Heyman Packing with high dose rate after loading. Endocurieth Hypertherm Oncol 8:11–18

    Google Scholar 

  54. Weitmann HD, Pötter R, Waldhause C et al (2005) Pilot study in the treatment of endometrial carcinoma with 3D image-based high-dose-rate brachytherapy using modified Heyman packing: clinical experience and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 62:468–478

    Article  PubMed  Google Scholar 

  55. Gill BS, Kim H, Houser C et al (2014) Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma. Brachytherapy 13:542–547

    Article  PubMed  Google Scholar 

  56. Nag S, Erickson B, Parikh S et al (2000) The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the endometrium. Int J Radiat Oncol Biol Phys 48:779–790

    Article  CAS  PubMed  Google Scholar 

  57. Stitt J (1991) Dose specification for inoperable endometrial carcinoma: the Madison system. Brachytherapy J 2:32–34

    Google Scholar 

  58. Beriwal S, Kim H, Heron DE, Selvaraj R (2006) Comparison of 2D vs 3D dosimetry for Rotte Y applicator high dose rate brachytherapy for medically inoperable endometrial cancer. Technol Cancer Res Treat 5:521–527

    Article  PubMed  Google Scholar 

  59. Mock U, Knocke TH, Fellner C et al (1998) Analysis of different application systems and CT-controlled treatment planning variants in the treatment of primary endometrial carcinomas: is brachytherapy treatment of the entire uterus technically possible? Strahlenther Onkol 174:320–328

    Article  CAS  PubMed  Google Scholar 

  60. Patel S, Tenapel M, Button A et al (2014) Impact on survival of brachytherapy in inoperable endometrial cancer: the (SEER) experience from 2004–2010. Int J Radiat Oncol Biol Phys 90:S111–S112

    Article  Google Scholar 

  61. Knocke TH, Kucera H, Weidinger B et al (1997) Primary treatment of endometrial carcinoma with high-dose-rate brachytherapy: results of 12 years of experience with 280 patients. Int J Radiat Oncol Biol Phys 37:359–365

    Article  CAS  PubMed  Google Scholar 

  62. Vargo JA, Boisen MM, Comerci JT et al (2014) Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria. Gynecol Oncol 135:190–195

    Article  PubMed  Google Scholar 

  63. Higgins RV, van Nagell JR, Horn EJ et al (1991) Preoperative radiation therapy followed by extrafascial hysterectomy in patients with stage II endometrial carcinoma. Cancer 68:1261–1264

    Article  CAS  PubMed  Google Scholar 

  64. Maruyama Y, Yoneda J, Coffey C et al (1992) Tandem-vaginal cylinder applicator for radiation therapy of uterine adenocarcinoma. Radiother Oncol 25:140–141

    Article  CAS  PubMed  Google Scholar 

  65. Boisen MM, Vargo JA, Beriwal S et al (2015) Surgical outcomes of patients undergoing extrafascial hysterectomy following neoadjuvant high-dose-rate brachytherapy for locally advanced endometrial cancer clinically extending to the cervix and parametria. Gynecol Oncol 137(Suppl 1):1–210

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Vargo, J.A., Viswanathan, A.N., Erickson, B.A., Beriwal, S. (2016). Gynecologic Brachytherapy: Endometrial Cancer. In: Montemaggi, P., Trombetta, M., Brady, L. (eds) Brachytherapy. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-319-26791-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26791-3_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26789-0

  • Online ISBN: 978-3-319-26791-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics