Perineal template interstitial brachytherapy salvage for recurrent endometrial adenocarcinoma metastatic to the vagina.
To evaluate the use of interstitial brachytherapy salvage of recurrent endometrial adenocarcinoma metastatic to the vagina. From September 1989 to February 1995, 15 patients with locally recurrent endometrial adenocarcinoma were treated with perineal template interstitial irradiation with low-dose-rate brachytherapy 192Ir/137Cs. Five of the 7 previously unirradiated patients received pelvic external beam radiation therapy (EBRT) of 45-50 Gy, with standard fractionation followed by an interstitial brachytherapy boost dose of 30 Gy (range 25 to 35 Gy). The other 2 patients received only brachytherapy of 40 Gy (palliative) and 50 Gy. Eight previously irradiated patients received only brachytherapy of 50 to 55 Gy. After a median follow-up of 47 months (range 14-81), the actuarial local control rate was 66.6%. The local control rate for patients treated with interstitial irradiation only was 64.3% and the local control rate for patients treated with interstitial irradiation + EBRT was 100%. Distant metastases occurred in 30.7% of the patients. Actuarial overall and disease-specific 5-year survival were 42.3 and 67.5%, respectively. Toxicity has been minimal, with 6 patients complaining of vaginal/rectal (RTOG) grade 1-3 complications (5 patients grade 1-2, 1 patient grade 3). These results suggest that perineal template interstitial irradiation (if possible with supplementary EBRT) is an effective alternative to radical or exenterative pelvic surgery for locally recurrent endometrial cancer. Excellent survival and local control rates can be achieved with low morbidity, especially if EBRT is added.