Postoperative high dose-rate intravaginal brachytherapy combined with external irradiation for early stage endometrial cancer: A long-term follow-up

Dattatreyudu Nori*, Ofer Merimsky, Mostafa Batata, Thomas Caputo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose:To evaluate the long-term control of disease and cure rate, complications, second malignancy, and survival of early-stage endometrial cancer patients treated with surgery, high dose-rate brachytherapy, and external beam radiation therapy. Methods and Materials:From 1969 through 1979, 300 patients with clinically staged Stage I-II endometrial cancer underwent total abdominal hysterectomy and bilateral salpingo-oopherectomy, followed by high dose-rate intravaginal radiation, 7 Gy × 3 to 0.5 cm from the mucosal surface, using a remote afterloading technique. External beam radiation therapy, 40 Gy to midplane in 4 weeks, was delivered to high risk patients through AP/PA and lateral fields. Results:The patients were followed for 5-24 years (median 12). The actuarial progression-free survival rate was 96.6%. Post-treatment grade 1-2 actuarial complication rate was 9.5%, including cystitis (4.5%), vaginal stenosis (2.5%), proctitis (1.5%), vaginal necrosis (0.5%), and partial bowel obstruction (0.5%). Neither grade 3-4 complications nor additional late complications were observed in any of our patients. Relapse rate was only 3.7%, of which 45.5% were local, 45.5% were distant, and 9% were mixed. All the patients with relapse were postmenopausal, age range of 58-77 years, with tumor grade 2-3 in 64%. Second primary cancer rate was 12.8% (mostly breast and colon). Factors that were associated with improved prognosis were young age, premenopausal, low grade, no extrauterine disease, and a histology of adenoacanthoma (adenocarcinoma with squamous metaplasia). Conclusion: High dose rate intravaginal radiation therapy combined with surgery and external beam radiation therapy achieved a high cure rate and small number of minor complications. No long-term treatment-related complications were noted in any of the patients. This treatment combination may be safely applied to patients with early stage endometrial cancer.

Original languageEnglish
Pages (from-to)831-837
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number4
StatePublished - 15 Nov 1994
Externally publishedYes


  • Brachytherapy
  • Endometrial cancer
  • High dose rate
  • Intravaginal treatment
  • Radiation therapy


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