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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30
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
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
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
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
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
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
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
NCCN clinical practice guidelines in oncology (NCCN Guidelines®) uterine neoplasms version 1 2015 (Nov 2014). Available at www.nccn.org
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
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
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
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
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
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
Tuncell N, Toy A, Demiral AN, Cetingoz R et al (2009) Dosimetric comparison of ring and ovoid applicators. J Buon 14:451–454
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Decruze SB, Guthrie D, Magnani R (1999) Prevention of vaginal stenosis in patients following vaginal brachytherapy. Clin Oncol (R Coll Radiol) 11:46–48
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
Lancaster L (2004) Preventing vaginal stenosis after brachytherapy for gynecological cancer: an overview of Australian practices. Eur J Oncol Nurs 8:30–39
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
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
Nguyen TV, Petereit DG (1998) High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer. Gynecol Oncol 71:196–203
Rouanet P, Dubois JB, Gely S, Pourquier H (1993) Exclusive radiation therapy in endometrial carcinoma. Int J Radiat Oncol Biol Phys 26:223–228
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
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
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
Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718
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
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
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
Gill BS, Kim H, Houser C et al (2014) Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma. Brachytherapy 13:542–547
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
Stitt J (1991) Dose specification for inoperable endometrial carcinoma: the Madison system. Brachytherapy J 2:32–34
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
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
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
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
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
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
Maruyama Y, Yoneda J, Coffey C et al (1992) Tandem-vaginal cylinder applicator for radiation therapy of uterine adenocarcinoma. Radiother Oncol 25:140–141
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
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights 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)