Endometrial Cancer_GEC ESTRO Handbook of Brachytherapy

Endometrial Cancer

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II: Clinical Practice Version 1 - 25/04/2016

External beam in combination with brachytherapy The incidence of late complications after definitive brachy­ therapy for uterine cancer is reported variously between 2% to 17.5%. In the series fromNancy using LDR brachytherapy, grade 1 complications were reported in 10% of the patients, grade 2 in 4.3%, grade 3 in 3% and grade 4 in 1.4% [58]. The complications were mostly located in the rectosigmoid. The complication rate has decreased significantly with the use of new techniques and computerized dosimetry. Similar experience has been reported

after HDR brachytherapy. The overall actuarial rate of side effects was 24% grade I, 5.7% grade II, and 5.2% grade III/IV. For the different organs, the actuarial rate of grade III/IV side effects were bladder 0.9%, rectum 0.4%, vulvovagina 0.8% and bowel 3.5% [75]. With the systematic use of 3 D image based treatment planning and the Heymann packing method in Vienna, the rate of side effects has been was significantly reduced in the last decade [74].

14. KEY MESSAGES

• Vaginal vault brachytherapy is indicated post-hysterectomy for intermediate risk endometrial cancer.

• Vaginal vault brachytherapy is indicated post-hysterectomy for high risk endometrial cancer in combination with external beam therapy when there has been cervial involvement

• Vaginal vault brachytherapy reduces local recurrence but may have no effect upon survival

• Vaginal vault brachytherapy has a low toxicity profile, the most common late effect being vaginal dryness and stenosis.

• Intrauterine brachytherapy using capsules or a Y applicator is indicated for stage I or II endometrial cancer in patients unfit for hysterectomy. • Intrauterine brachytherapy using capsules or a Y applicator is indicated with external beam therapy in stage III endometrial cancer.