Vaginal Cuff Brachytherapy in Endometrial Cancer

Abstract

Endometrial cancer is the most common gynecological cancer in developed countries, and its etiopathogenesis includes obesity, metabolic syndrome and unopposed estrogen effect. Therefore, the incidence is increasing and it is estimated to double in 2030. The main treatment modality is surgery, radiotherapy has role for inoperable patients and adjuvant period. Although adjuvant radiotherapy (external and/or brachytherapy) is possible, there are different literature information about indications and methods of administration. Stage and risk factors are important criteria for adjuvant treatment decision in today’s routine clinical practice, grade of tumor, myometrial invasion, lymphatic vascular invasion (LVI (+)), tumor size, lymph node status, extension of tumor to cervix or vagina, age, type of surgery, and other comorbid conditions are all factors under consideration to determine the type and decision of adjuvant therapy. It has been shown that, of molecular markers which are effective on survival, POLE mutation leads to good prognosis and L1CAM and TP53 lead to poor prognosis and increased metastasis rate, and these molecular differences can also be utilized in designing adjuvant therapy in the future. When compared to the risk groups, radiotherapy reduces the risk of recurrence in the low-risk group from 5-6% to 2% and in the moderate-risk group from 12-15% to 3-6%. In the high-moderate risk group, it reduces from 18-26% to 5-6%. Vaginal brachytherapy is a preferred method to prevent the recurrence of vaginal cuff with far fewer side effects than external radiotherapy. The literature review showed that there are 24 different types of single application protocol and 22 different application protocols after external radiotherapy. In the treatment of endometrium cancer, vaginal cuff radiotherapy provides excellent results in disease control with a very low side effect rate, if applied properly and for the correct indication. © 2019, Turkish Society for Radiation Oncology.