PO-1021: A practical MRI based reconstruction method for the new endocavitary and interstitial gynecological template

J. Richart Sancho, A. Otal, S. Rodriguez, M. De Piaggio, M. Santos, A.I. Nicolás, J. Perez Calatayud
2015 Radiotherapy and Oncology  
157 pts (median age 64 years -range 39-84) were enrolled. All pts underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy; patological stage (FIGO 2008) was I in 150 pts and II in 7 pts. Tumour grading was G1 in 49 pts, G2 in 98 and G3 in 10. All pts underwent high-dose-rate vaginal brachytherapy (total dose 21 Gy in three week-fractions), delivered with vaginal cylinder, with the reference isodose covering the proximal ½ of the vagina.
more » ... l ½ of the vagina. The dose was specified at 5 mm distance from the cylinder surface. The Kaplan-Meier method estimated the probability of locoregional relapse free survival (LRFS), distant metastases-free survival (DMFS) and cancer-specific survival (CSS). Univariate analysis investigated the effect of age, grading, number of excised nodes and pathological stage on loco-regional relapse (LRR), metastases, and tumour-related death. Risk factors in univariate analysis were included in proportional hazard multivariate models. Vaginal toxicity was evaluated with the RTOG/EORTC scale and was correlated with the cylinder diameter (2.5, 3 or 3.5 cm). Results: LRFS occurred in 9/157 (5.8%) pts. Three pts (1.9%) developed liver metastases. At median follow-up of 83 months 144 pts (91.8%) are alive and disease free, 2 pts (1.2%) are alive with disease, 7 pts (4.5%) died from disease and 4 pts (2.5%) died from other causes. The 3-year probability of LRFS, DMFS and CSS was 94.5% (95%CI:89.4-97.2), 98.7% (95% CI: 94.9-99.7) and 96,5% (95% CI: 91.8-98.5) respectively. Median survival was nor reached for any endpoints. At univariate analysis, risk factors for LRR were stage pII (HR: 3.638; 95% CI:1.3-9.8; p=0.011) and less than 12 excised nodes (HR: 7.057; 95% CI:1.6-29.5; p=0.008), while Stage pII was risk factor for metastasis (HR: 22.7; 95%CI:2.392-215.4; p=0.007) and tumour-related death (HR: 4.043; 95% CI: 1.2-13.2; p=0.021). In multivariate Coxregression analysis, stage pII and less than 12 nodes sampled were significantly associated with LRR (HR: 3.88; 95%CI:1.390-10.878; p=0.010 and HR: 6.952; 95%CI: 1.591-30.385; p=0.010), whereas only stage pII was associated with metastasis (HR: 23.1; 95%CI: 2.296-231.485; p=0.008) and tumour-related death (HR: 4.324; 95% CI: 1.223-15.290; p=0.023). Treatment was well tolerated. No pts developed acute or late grade III-IV toxicity. No correlation between the diameter of the applicator and the onset of acute (p=0.512) and chronic (p=0.433) toxicity was observed . Conclusions: Post-operative VBT in pts with early stage endometrial cancer is effective in ensuring vaginal control, with fewer toxic effects. PO-1021 A practical MRI based reconstruction method for the new endocavitary and interstitial gynecological template
doi:10.1016/s0167-8140(15)41013-8 fatcat:oyrbctsdlzeodfojoewbgmubbi