Toward four-dimensional image-guided adaptive brachytherapy in locally recurrent endometrial cancer

PURPOSE: To evaluate clinical outcome and feasibility of a four-dimensional image-guided adaptive brachytherapy concept in patients with locally recurrent endometrial cancer. METHODS AND MATERIALS: Forty-three patients with locally recurrent endometrial cancer were included. Treatment consisted of conformal external beam radiotherapy followed by a boost using pulsed-dose-rate brachytherapy (BT). Large tumors were treated with MRI-guided interstitial BT. Small tumors were treated with CT-guided intracavitary BT. The planning aim (total external beam radiotherapy and BT) for high-risk clinical target volume was D-90 > 80 Gy, whereas constraints for organs at risk were D-2cc <= 90 Gy for bladder and D-2cc <= 70 Gy for rectum, sigmoid, and bowel in terms of equivalent dose in 2 Gy fractions. RESULTS: Median high-risk clinical target volume was 18 cm(3) (range, 0-91). D-90 was 82 Gy (range, 77-88). D-2cc to bladder, rectum, and sigmoid were 67 Gy (range, 50-81), 67 Gy (range, 51-77), and 55 Gy (range, 44-68), respectively. Median followup was 30 months (6-88). Two-year local control rate was 92% (standard error [SE], 5). Disease-free survival rate and overall survival rate was 59% (SE, 8) and 78% (SE, 7), respectively. Patients with low- to intermediate-risk for recurrence had a 2-year disease-free survival rate of 72% (SE, 9) compared with 42% (SE, 12) in patients with high risk for recurrence (p = 0.04). Late morbidity Grade 3 was recorded in 5 (12%) patients. CONCLUSIONS: Four-dimensional image-guided adaptive brachytherapy is feasible in locally recurrent endometrial cancer. Local control rate is good. Systemic control remains a problem in patients with high risk for recurrence. (C) 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.