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External Pelvic and Vaginal Irradiation Versus Vaginal Irradiation Alone as Postoperative Therapy in Medium-Risk Endometrial Carcinoma: A Prospective, Randomized Study—Quality-of-Life Analysis
  1. Bengt Göran Sorbe, MD, PhD*,
  2. György Horvath, MD, PhD,
  3. Håkan Andersson, MD, PhD,
  4. Karin Boman, MD, PhD,
  5. Caroline Lundgren, MD, PhD§ and
  6. Birgitta Pettersson, MD, PhD
  1. *Department of Gynecological Oncology, Örebro University Hospital, Örebro;
  2. Department of Gynecological Oncology, Sahlgrenska University Hospital, Gothenburg;
  3. Department of Gynecological Oncology, Umeå University Hospital, Umeå;
  4. §Department of Gynecological Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm; and
  5. Medical Products Agency, Uppsala, Sweden.
  1. Address correspondence and reprint requests to Bengt Göran Sorbe, MD, PhD, Department of Oncology, Örebro University Hospital, SE-701 85 Örebro, Sweden. E-mail: bengt.sorbe{at}orebroll.se.

Abstract

Background A combination of vaginal brachytherapy and external beam radiotherapy was compared with brachytherapy alone in medium-risk endometrial carcinomas. Quality-of-life analysis is an important part of a randomized study to find out the optimal adjuvant treatment for this group of patients.

Objective To evaluate the value of adjuvant external beam pelvic radiotherapy in adjunct to vaginal brachytherapy in medium-risk endometrial carcinoma. Quality-of-life evaluation is the main topic of this report.

Methods A consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study end points were locoregional recurrences and overall survival. Secondary end points were recurrence-free survival, toxicity, and quality-of-life. European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-OV28 modules were used to evaluate global health status, functional scales, and symptom scales.

Results Five-year locoregional relapse rates were 1.5% after external beam (ERT) plus vaginal irradiation (VBT) and 5% after vaginal irradiation alone (P = 0.013), and 5-year overall survival (OS) rates were 89% and 90%, respectively. External beam radiotherapy was associated with a higher rate of adverse effects from the intestine and the bladder, and quality-of-life parameters deteriorated at the end of radiotherapy but recovered to normal levels within a few months. There was a significant difference in favor of VBT alone with regard to adverse effects of the bowel and urinary tract, and quality-of-life.

Conclusions Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded; but increased late toxicity from the intestine and the bladder. External beam irradiation decreased global health status during and after treatment, and 3 functional scale items (physical, role, and social). Six of 11 symptom items showed a pattern favoring vaginal brachytherapy alone.

  • Endometrial cancer
  • Medium-risk group
  • Postoperative radiotherapy
  • Quality-of-life

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Footnotes

  • The authors declare no conflicts of interest.

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