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37 Intracavitary brachytherapy as the method of choice in fragile patients with early-stage endometrial cancer
  1. A Rychlik,
  2. M Rydzinski and
  3. A Zolciak-Siwinska
  1. National Research Cancer Institute in Warsaw, Poland


Introduction/Background*In patients presenting with fragility syndrome or morbid obesity an individualised treatment is required. Intracavitary brachytherapy is a technique which allows to deliver high dose radiation to the uterine corpus sparing adjacent organs. This technique can be the method of choice in the group of fragile patients with early-stage endometrial cancer. We present a series of patients diagnosed of FIGO stage I and II endometrial carcinoma treated exclusively with intrauterine brachytherapy.

Methodology 57 patients with early-stage endometrial cancer treated by brachytherapy from 2011 to 2017 in National Research Institute of Oncology were included. All but two patients presented endometrioid histology. 54 patients were classified as FIGO stage I and 5 patients were FIGO stage II. The vast majority of patients (70.1%) presented with obesity superior to body max index 30. The contraindication from surgical or external beam radiotherapy were related to a combination of comorbidities, advanced age and morbid obesity. High dose rate intracavitary brachytherapy with Rotte applicator, uterine probe or Fretcher applicator with uterine probe were used and 3-dimmensional planning according to computed tomography were performed. 52.5Gy per 7 fractions in 43 patients, 45Gy per 6 fractions in 1 patient and 45Gy per 5 fractions in 13 patients were delivered.

Result(s)*After a follow up of 5 years, 11 (19.3%) patients recurred. There were 6 (10.5%) local recurrences (54.5% of recurrences), and 5 distant recurrences (45.5%). A total of 25 (44,5%) patients died and, of these, 7 patients (12.7%) died of disease. Cancer non-related deaths were more common in this cohort of patients and represented 31,8%. Early and late side effects were not observed in this series. Early complications in the form of bleeding after insertion of applicators were not observed.

Conclusion*Exclusive brachytherapy is feasible and safe management in fragile patients with endometrial cancer FIGO stage I or II. Their survival outcome is more conditioned by the associated comorbidities than by the evolution of oncological disease.

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