Brachytherapy in vaginal cancer for organ preservation: Clinical outcome and safety from a single center experience

• Published in: Gynecologic oncology 2024-11, Vol.190, p.35-41
• Main Authors: Merten, Ricarda, Strnad, Vratislav, Karius, Andre, Lotter, Michael, Kreppner, Stephan, Schweizer, Claudia, Fietkau, Rainer, Schubert, Philipp
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - methods; Disease-Free Survival; Dose-escalation; Female; Humans; Middle Aged; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Staging; Organ Sparing Treatments - methods; Organ-sparing; Radiotherapy Dosage; Retrospective Studies; Treatment Outcome; Vaginal cancer; Vaginal Neoplasms - pathology; Vaginal Neoplasms - radiotherapy
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2024.07.683

Interstitial and/or intracavitary brachytherapy is an integral part of the treatment of vaginal cancer Brachytherapy (BT) has shown to improve local control, overall survival (OS) and disease-free survival (DFS). The aim of our study was to analyze the efficacy and safety of brachytherapy in patients with vaginal cancer. Between 2000 and 2023, 27 patients with vaginal cancer in stage FIGO I-III were treated with brachytherapy with or without external beam radiotherapy (EBRT) and simultaneous chemotherapy. Brachytherapy has been performed either as PDR-brachytherapy alone with a median cumulative dose up to 62.5 Gy (EQD2 = 63.9 Gy) or with PDR-BT boost with median dose of 30.9 Gy (EQD2 = 30.4 Gy). HDR-BT was administered solely as boost with a median dose of 25.5 Gy (EQD2 = 47.8 Gy). The median dose of EBRT was 48.7 Gy and 49.4 Gy for primary and for pelvic lymph nodes. Median follow-up was 39 months (2−120). 5/27 patients developed local recurrences and the 5-year cumulative local recurrence rate for whole patient population was 18.5%. 5-year OS and DFS was 90% and 68%. 5-year DFS for Stage I-II was 72% and for Stage III 65% (p = 0.933). Grade 3 late side effects of brachytherapy were documented in 3/22 patients (13.6%), one patient experienced Grade 4 toxicity (4.5%). Brachytherapy with or without EBRT and concomitant chemotherapy for vaginal cancer is a safe and effective treatment option with excellent local control and overall survival and acceptable toxicity. •There are few organ-sparing treatment options when treating vaginal cancer.•External beam radiotherapy alone is a possible treatment strategy, but it often fails to achieve curative doses.•Brachytherapy allows for dose-escalation while still preserving surrounding organs at risk.•Combined EBRT and image-guided BT has shown encouraging outcomes in both survival rates and local disease control.