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