Introduction/Background External pelvic radiation therapy (EPRT) is recommended in stage IB grade 3 endometroid type endometrial cancer (EC) patients with substantial lymphovascular invasion (LVI), however, the role of EPRT is controversial in patients with lymph node dissection (LND). The aim of this study is to compare EPRT and vaginal brachytherapy (VBT) in terms of oncological outcomes and toxicity in these patients.
Methodology The records of 63 patients with stage IB grade 3 endometroid type EC according to FIGO 2018, who were treated between 1994–2000, were retrospectively evaluated. The patients who received only EPRT and the patients who received VBT after EPRT were examined in the same category due to small number of patients. Survival estimates were calculated with Kaplan Meier test (IBM SPSS v24).
Results The median age and tumor size was 62 (37–78) and 4 cm (1.3–13 cm), respectively. The tumor and treatment characteristics were similar between treatment groups (table 1). The median number of dissected LN was 37 (12–110). LVI was observed in 31 (49%) patients. With a median follow up of 108 months (15–336 months), LRR and survival rates were similar between treatment groups. EPRT had no survival benefit in patients with LVI. In this group of patients, LRR rates were 13% and 0% in VBT and EPRT groups, respectively (p=1.000). In all cohort, treatment was well tolerated. Late vaginal toxicity was observed in 3 (5%) patients. Vaginal toxicity was higher in EPRT group than VBT group, although it did not statistically significant (9% vs 4%, p=0.443).
Conclusion The survival outcomes of VBT alone and EPRT±VBT in patients with stage IB grade 3 endometroid type EC were similar. However, in the presence of LVI, EPRT seems to be an ideal option even in patients who had surgical staging.
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