Adjuvant radiotherapy for IB endometrial cancer : historic comparison between treatment regimens in a same institution / Radioterapia adjuvante no cancer do endometrio IB : comparação historica entre regimes de tratamento em uma mesma instituição

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Objectives: To compare the rates of overall survival, disease-free survival and toxicity in different techniques of postoperative radiotherapy for stage IB, histologic grades 1 and 2 endometrial cancer. Methods: A historical comparison between treatments was made, including 133 women diagnosed with stage IB, histologic grades 1 and 3 endometrial endometrioid adenocarcinoma. Minimum follow-up was 5 years. Treatment was provided from 1988 to 2004 in our institution. From 1988 to 1996, teletherapy (Tele group) was administered by a 10 MV linear accelerator to 22 patients using a four-field technique. Mean pelvic dose was 46.2 Gy in 1.8-2 Gy daily fractions, five times a week. Between 1992 and 1995, low-dose-rate brachytherapy (LDRB group) was given to 19 women with insertion of cesium-137, at a dose of 60 Gy. Between 1990 and 1996, fourteen women underwent surgery and received no adjuvant radiotherapy (NO RT group). From 1996 to 2004, high-dose-rate brachytherapy was given to 78 patients (HDRB group), at a dose of 7Gy in five fractions per week. Prescription dose was delivered at 0.5 cm depth from the surface of the vaginal cylinder, which was 4 cm in length. Acute and late toxicities were scored according to the Common Toxicity Criteria scale and the Radiation Therapy Oncology Group Toxicity Criteria. Survival time was described by survival curves, generated by the Kaplan-Meier method, comparing time periods associated with treatment groups. A statistical significance level was set at 5%. Results: The 5 yeardisease- free survival was 94.6% for the HDRB group, 94.1% for the LDRB group, 100% for the Tele group and 100% for the NO RT group (p=0.681). The 5-year overall survival was 86.6% for the HDRB group, 89.5% for the LDRB group, 90% for the Tele group and 90% for the NO RT group (p = 0.962). Late grade 1 and 2 radiotherapy-related toxicity occurred in 18% of the HDRB group, 10.5% of the LDRB group, and 1% of the Tele group. Late grade 3-5 toxicity did not occur in the HDRB group, but occurred in 5.3% of the LDRB group and 27.3% of the Tele group (p <0.001). Worsening of severe toxicity was related to a radiation dose higher than 45Gy (p<0.001). Conclusion: Patients undergoing adjuvant teletherapy had more severe toxicity, contraindicating this treatment for these patients, especially at doses above 45Gy. There may be a role for adjuvant HDRB in the treatment of these women. However, further randomized controlled trials are still needed to clarify these points

ASSUNTO(S)

endometrial neoplasms braquiterapy cancer do endometrio radiotherapy radioterapia braquiterapia

ACESSO AO ARTIGO

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