Background: Basis for adjuvant strategies for patients with endometrial carcinoma is a postoperative staging including criteria such as myometrial tumor infiltration and histological grading. Such adjuvant strategies include afterloading therapy of the vagina as a long-established therapeutic concept. Our aim was to investigate the influence of the target volume on treatment results (i.e. local tumor control, side effects) in these patients.
Patients and method: At Jena University, Department of Radiotherapy, from 1981 to 1990 108 patients with endometrial carcinoma were postoperatively treated with high dose radiation brachytherapy of the vagina without additional percutaneous radiotherapy. Histology showed more or less differentiated adenocarcinoma in 90% of all patients, all patients were postoperatively stage I or II without proven lymphatic metastases. Dependent on individual figures patients were distributed to 3 different groups: group A: 4 x 10 Gy, tissue-thickness of 1 cm (vaginal apex) respectively 0.5 cm (lower vaginal walls); group B: 4 x 10 Gy, tissue thickness of 1 cm (upper vaginal wall); group C: 4 x 10 Gy, tissue-thickness of 0.5 cm (both excluding the lower vaginal walls).
Results: Both 3-year survival rates (group A: 96.6%, group B: 96.9%, group C: 97.7%) and tumor relapse rates of the vaginal apex (group A: 0, group B: 3.1%, group C: 2.2%) don't show significant differences. No case of local tumor recurrence was seen in the upper 2/3 of the vagina and the pelvic walls. Late side effects concerning bladder and rectum (grade III to IV, EORTC/RTOG) could be minimized by reducing the treatment volume (group A: 6.8%/12.6%, group B: 6.2%/3.1%, group C: 2.2%/0).
Conclusions: Our results show the value of postoperative afterloading brachytherapy in patients with endometrial carcinoma, the brachytherapy of the upper vaginal wall is a sufficient therapeutic concept. Radiotherapy of the lower vaginal walls does not contribute to better tumor control, while it does significantly increase the number of unwanted side-effects in our investigation.