Advertisement

Clinical Outcome of Exclusively Radiographer-led Delivery of Postoperative Vaginal Vault Brachytherapy for Endometrial Cancer – The Addenbrooke's Experience

      Highlights

      • Radiographer-led delivery of radiotherapy services maximises skills mix.
      • Vaginal vault brachytherapy delivered exclusively by radiographers is safe.
      • Despite no image guidance, the 5-year isolated vaginal recurrence rate was only 2.3%.
      • Late bowel and bladder toxicity was minimal.

      Abstract

      Aims

      Postoperative vaginal vault brachytherapy (VBT) reduces local recurrence in operable endometrial cancer. Radiographer-led delivery of VBT, carried out without image guidance, was implemented at Addenbrooke's in 2010 to maximise skills mix and to improve service delivery. The purpose of this study was to evaluate the safety and effectiveness of this service.

      Materials and methods

      This was a single-centre retrospective study of endometrial cancer patients treated with postoperative high dose rate VBT ± external beam radiotherapy (EBRT) between January 2010 and December 2016.

      Results

      In total, 414 patients were analysed: 307 received adjuvant VBT alone and 107 patients received pelvic EBRT followed by VBT. Thirty-seven per cent of patients receiving VBT alone were high risk according to ESMO-ESGO-ESTRO criteria. After a median follow-up of 59 months (range 2–118), 9/414 (2.2%) patients had isolated vaginal recurrences, 15/414 (3.6%) had locoregional recurrence (vaginal, pelvic node or both), whereas 62/414 (15%) patients had distant recurrence. The 5-year actuarial isolated vaginal recurrence rate was 2.3% (VBT alone 2.1%, EBRT + VBT 3.0%). Grade 3 urinary or bowel toxicity occurred in 2/414 (0.6%) patients treated with EBRT and VBT. None of the patients treated with VBT alone had grade 3 complications.

      Conclusion

      Radiographer-led delivery of VBT, without the use of image guidance, is a safe and effective service.

      Key words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Clinical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Creutzberg C.L.
        • van Putten W.L.
        • Koper P.C.
        • Lybeert M.L.
        • Jobsen J.J.
        • Warlam-Rodenhuis C.C.
        • et al.
        Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma.
        Lancet. 2000; 355: 1404-1411
        • Keys H.M.
        • Roberts J.A.
        • Brunetto V.L.
        • Zaino R.J.
        • Spirtos N.M.
        • Bloss J.D.
        • et al.
        A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study.
        Gynecol Oncol. 2004; 92: 744-751
        • Creutzberg C.L.
        • Nout R.A.
        • Lybeert M.L.
        • Warlam-Rodenhuis C.C.
        • Jobsen J.J.
        • Mens J.W.
        • et al.
        Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma.
        Int J Radiat Oncol Biol Phys. 2011; 81: e631-e638
        • Nout R.A.
        • Smit V.T.
        • Putter H.
        • Jurgenliemk-Schulz I.M.
        • Jobsen J.J.
        • Lutgens L.C.
        • et al.
        Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial.
        Lancet. 2010; 375: 816-823
      1. The NHS Cancer Plan: a plan for investment, a plan for reform. Department of Health, 2000
        • Colombo N.
        • Creutzberg C.
        • Amant F.
        • Bosse T.
        • Gonzalez-Martin A.
        • Ledermann J.
        • et al.
        ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up.
        Radiother Oncol. 2015; 117: 559-581
        • Wortman B.G.
        • Creutzberg C.L.
        • Putter H.
        • Jurgenliemk-Schulz I.M.
        • Jobsen J.J.
        • Lutgens L.
        • et al.
        Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy.
        Br J Cancer. 2018; 119: 1067-1074
        • Barney B.M.
        • Petersen I.A.
        • Mariani A.
        • Dowdy S.C.
        • Bakkum-Gamez J.N.
        • Haddock M.G.
        The role of vaginal brachytherapy in the treatment of surgical stage I papillary serous or clear cell endometrial cancer.
        Int J Radiat Oncol Biol Phys. 2013; 85: 109-115
        • Eldredge-Hindy H.B.
        • Eastwick G.
        • Anne P.R.
        • Rosenblum N.G.
        • Schilder R.J.
        • Chalian R.
        • et al.
        Adjuvant vaginal cuff brachytherapy for high-risk, early stage endometrial cancer.
        J Contemp Brachyther. 2014; 6: 262-270
        • Harkenrider M.M.
        • Block A.M.
        • Alektiar K.M.
        • Gaffney D.K.
        • Jones E.
        • Klopp A.
        • et al.
        American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: a comprehensive review.
        Brachytherapy. 2017; 16: 95-108
        • Nout R.A.
        • Putter H.
        • Jurgenliemk-Schulz I.M.
        • Jobsen J.J.
        • Lutgens L.C.
        • van der Steen-Banasik E.M.
        • et al.
        Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data.
        Eur J Cancer. 2012; 48: 1638-1648
        • Small Jr., W.
        • Beriwal S.
        • Demanes D.J.
        • Dusenbery K.E.
        • Eifel P.
        • Erickson B.
        • et al.
        American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy.
        Brachytherapy. 2012; 11: 58-67
        • Harkenrider M.M.
        • Grover S.
        • Erickson B.A.
        • Viswanathan A.N.
        • Small C.
        • Kliethermes S.
        • et al.
        Vaginal brachytherapy for postoperative endometrial cancer: 2014 survey of the American Brachytherapy Society.
        Brachytherapy. 2016; 15: 23-29
        • Richardson S.
        • Palaniswaamy G.
        • Grigsby P.W.
        Dosimetric effects of air pockets around high-dose rate brachytherapy vaginal cylinders.
        Int J Radiat Oncol Biol Phys. 2010; 78: 276-279
        • Cameron A.L.
        • Cornes P.
        • Al-Booz H.
        Brachytherapy in endometrial cancer: quantification of air gaps around a vaginal cylinder.
        Brachytherapy. 2008; 7: 355-358
        • Chapman C.H.
        • Prisciandaro J.I.
        • Maturen K.E.
        • Cao Y.
        • Balter J.M.
        • McLean K.
        • et al.
        MRI-based evaluation of the vaginal cuff in brachytherapy planning: are we missing the target?.
        Int J Radiat Oncol Biol Phys. 2016; 95: 743-750
        • Humphrey P.
        • Cornes P.
        • Al-Booz H.
        Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement.
        Br J Radiol. 2013; 86: 20120428