Researchers from the Netherlands have reported that vaginal brachytherapy (VBT) may be a better treatment choice than external beam radiotherapy (EBRT) for women with high-intermediate risk endometrial cancer. The details of this randomized Phase III study were presented as a late-breaking abstract at the 2008 meeting of the American Society of Clinical Oncology (ASCO) in Chicago, May 30-June 2.¹ Preliminary results of this study were previously presented at the European Cancer Conference (ECCO 14) in Barcelona, Spain, in September of 2007 (see first item in related news).

Patients with endometrial cancer requiring adjuvant radiotherapy have two choices of therapy: external beam radiation therapy or vaginal brachytherapy. Currently, the relative efficacy of these two approaches is unknown.

This study included 427 women with Stage IB, IC, or IIA endometrial cancer who were randomly allocated to receive VBT or EBRT. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. The median follow-up was 34 months.

The study was designed to address both treatment effectiveness and impact on quality of life. The following table summarizes the main efficacy endpoints of this study. Quality-of-life endpoints were previously presented at ECCO 14.

* First failure rates

• In both groups of patients, quality of life was lowest after surgery and then gradually improved.
• From six months onwards, patients who had received VBT reported better overall quality of life than patients who received EBRT.
• Patients who had received VBT reported fewer bowel symptoms (such as diarrhea) and less fatigue than patients who received EBRT.
• There was no significant difference between the groups in sexual symptoms (such as vaginal dryness) or sexual interest.

Comments: These authors concluded that quality of life was better after VBT than after EBRT. Even though there was a higher rate of pelvic relapse, they suggest that VBT should be the treatment of choice for women with high-intermediate risk endometrial cancer.

Related News:

Better Quality of Life with Vaginal Brachytherapy for Endometrial Cancer (10/5/2007)

Brachytherapy Effective for Stage I Endometrial (Uterine) Cancer (8/12/2005)

Adjuvant Chemotherapy Effective for Advanced Endometrial Cancer (2/14/2006)

Adjuvant Radiation Therapy May Improve Outcomes of Stage IC Uterine Cancer (1/30/2006)

Reference:

¹ Nout RA, Putter H, Jurgenliemk-Schulz IM, et al. Vaginal brachytherapy versus external beam pelvic radiotherapy for high-intermediate risk endometrial cancer: Results of the randomized PORTEC-2 trial. Journal of Clinical Oncology. 2008;26:abstract LBA5503.