Benefits Of Brachytherapy In Addition To External Beam Radiation In Early-Stage Endometrial Carcinoma: Analysis From A Multicenter Study

To investigate the benefits of vaginal brachytherapy (VBT) in addition to external beam radiation (EBRT) on the basis of locoregional control improvements in early stage endometrial carcinoma. Review of clinical data of patients with early-stage EC at 11 institutions in China between 2000 and 2016. Eligibility requirements included the primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy, stage I and II disease (FIGO 2009 staging), and complete clinicopathologic and follow-up information. All patients were divided into low-, intermediate-, high-intermediate and high-risk groups according to ESMO-ESGO-ESTRO Consensus. Overall survival (OS), disease free survival (DFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were calculated using the Kaplan–Meier method, Cox proportional hazards regression model was used for multivariate analysis. Pearson chi-Square test was used to compare categorical variables between groups. Statistical analyses were performed with statistical software. A total of 909 early-stage patients were reviewed. The median follow-up time was 48 months (range 6–207 months). The median age was 57 years (range 23–86 years). Stage Ia/b disease represented 87.6% of the cohort, high-risk patients 20.8%. Patients received VBT alone (n = 426), EBRT alone (n = 117), EBRT+VBT (n = 366), and chemotherapy(n = 183). The 5-year OS, DFS, LRFS, and DMFS rates for all patients were 94%, 89.6%, 91.8%, and 91% respectively. Age>60, anemia before radiotherapy, and presence of lymphovascular invasion (LVSI) were found to be significant prognostic factors for OS (p = 0.016, 0.026, and 0.017). Myometrial invasion>1/2, anemia before radiotherapy, LVSI, and lower uterine segment involvement (LUSI) were found to be significant prognostic factors for DFS (p = 0.031, 0.011, 0.008, and 0.03). Subgroup analysis revealed that 62.8% of high-risk patients received EBRT+VBT, Patients received EBRT+VBT had significantly higher LRFS than patients received EBRT or VBT alone (89.7%, 86%, 76.7%, p = 0.002). For high-risk early-stage EC, VBT in addition to EBRT maybe a better option with improvement of LRFS.