Excellent local control and minimal toxicity with salvage intensity-modulated radiotherapy and high-dose-rate brachytherapy for vaginal recurrence of endometrial cancer: A 10-year retrospective analysis
Notice bibliographique
Résumé
Purpose: Salvage external beam radiation therapy (EBRT) followed by vaginal brachytherapy is commonly used to treat patients with vaginal recurrence of endometrial cancer, but limited data are available in the era of modern radiotherapy with intensity-modulated radiotherapy (IMRT) and high-dose-rate brachytherapy (HDR-BT). Our study aimed to assess survival outcomes and late toxicities associated with the combined treatment modality. Material and methods: A retrospective review of 26 patients with biopsy-proven vaginal recurrence after surgically treated endometrial cancer, for whom salvage EBRT followed by HDR-BT were performed between February 2013 and September 2022. Median EBRT dose was 50 Gy (range, 45-59.4 Gy), and median HDR-BT was 16 Gy (range, 12-24 Gy). Recurrence-free intervals and overall survival (OS) rates were evaluated. Complications were assessed in terms of late RTOG toxicity (grade 3 or higher) of gastrointestinal tract, genitourinary tract, and vagina. Kaplan-Meier and Cox proportional hazards modeling were used to estimate survival. Severe (grade 3 or higher) radiation-related toxicities defined according to RTOG were recorded. Endpoints were measured from the date of diagnosis of vaginal recurrence. Results: The median follow-up was 36.8 months (range, 4.2-97.8 months). The median age at recurrence was 65.5 years (range, 41-91 years), and the median time to recurrence from primary diagnosis was 20.6 months (range, 2.8-148.1 months). The most common symptom was per vaginal bleeding (30.8%) and vaginal spotting (23.1%). Twenty-four patients (92.3%) had central recurrence (18 vaginal apex, six distal vagina), and two patients (7.7%) had pelvic nodal recurrence with central recurrence. The median tumor size at recurrence was 1.5 cm (range, 0.4-5.0 cm). Eight patients developed a distant recurrence and five of them died due to the disease, with 5-year local control, disease-specific survival, and distant metastatic-free survival rates of 100%, 80.8%, and 69.2%, respectively. The median OS was 91.1 months (range, 15.7-1,503.6 months), and the median distant recurrence-free survival was 46.1 months (range, 7.7-133.8 months). Primary tumor high-grade and stage III were prognostics for poor OS (7.7% and 0%) and distant metastases-free survival (11.5% and 3.8%), respectively. No severe grade 3 or higher late toxicities were observed. Conclusions: Recurrent vaginal endometrial cancer is amenable to salvage therapy using HDR-BT and EBRT. This combined treatment modality demonstrates excellent loco-regional control and minimal morbidity for vaginal recurrence of endometrial cancer. Early radiotherapy, including brachytherapy, should be considered for women with vaginal recurrence of endometrial cancer.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».