Clinical outcomes and recurrence patterns of high-intermediate-risk and high-risk early-stage endometrial cancer treated with postoperative intracavitary brachytherapy

To investigate the clinical outcomes and recurrence patterns of high-intermediate-risk (HIR)- and high-risk (HR) early-stage endometrial cancer (EC) treated with postoperative intracavitary brachytherapy alone.

We included 152 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-II endometrial cancer with HIR and HR factors who received vaginal brachytherapy alone after surgery in our center between April 2008 and December 2017. The irradiation area was the top and upper halves of the vagina. The reference point was defined as 0.5 cm below the vaginal mucosa. The radiation dose was 25–30 Gy 5–6 times. The Kaplan–Meier method was used to calculate the survival rate; differences were assessed using the log-rank test, and univariate and multivariate prognostic analyses were performed using the Cox regression model.

The median follow-up was 49.2 months (range 3–132 months). The 5-year overall survival (OS), disease-free survival (DFS), locoregional failure-free survival time (LRFS), and distant metastasis-free survival (DMFS) rates were 93.2%, 83.4%, 87.9%, and 86.6%, respectively. Treatment failure occurred in 18 patients, locoregional recurrence in 11, and distant metastasis in 14 (four with locoregional recurrence). Distant metastasis is the main recurrence pattern in patients at HIR and HR. Univariate and multivariate analyses revealed that age was an independent prognostic factor for OS, DFS, DMFS, and LRFS.

The main recurrence pattern after adjuvant vaginal brachytherapy alone was distant metastasis in patients with HIR and HR early-stage EC. Age at onset was an independent prognostic factor for survival. Vaginal brachytherapy alone is an acceptable treatment option for patients with HIR and HR early-stage endometrial cancer.