Brachytherapy for early endometrial carcinoma: a comparative study with long‐term follow‐up

The current study was undertaken to evaluate the effect of preoperative uterine or postoperative vaginal brachytherapy compared to no adjuvant therapy on the disease‐free interval, sites of recurrence, and survival in favorable stage IB endometrial carcinoma. One hundred and forty‐six patients with FIGO grade 1 and 2 endometrial carcinoma and 1–33% myometrial invasion treated between 1974 and 1992 were retrospectively studied. The use of brachytherapy varied among the treating physicians during the study period. A Kaplan‐Meier survival analysis was used to estimate disease‐free survival and differences between treatment groups were evaluated with the Mantel‐Cox statistic. Recurrent disease occurred in 7 patients (5.3%). Vaginal recurrences accounted for 6 of the 7 sites of recurrences. Recurrences occurred in 1.3% of grade 1 vs. 8.7% of grade 2 tumors ( P = 0.04). Among 69 grade 2 tumors, recurrences occurred in 7.5% of those treated with brachytherapy vs. 10.3% of those not treated ( P = 0.68). Brachytherapy did not affect the disease‐free or overall survival. No serious complications directly related to therapy occurred. Vaginal recurrences occur even in early endometrial carcinoma. This study demonstrates no apparent benefit to brachytherapy. A larger study would be required to see a recurrence or survival difference.