High dose–rate intracavitary brachytherapy for carcinoma in situ of the vagina occurring after hysterectomy: A rational prescription of radiation dose

Objective: Our purpose was to profile patients who were treated with high dose-rate intracavitary brachytherapy for carcinoma in situ of the vagina that occurred after hysterectomy, with special reference to a rational prescription of radiation dose. Study Design: We reviewed 13 patients who were treated for posthysterectomy carcinoma in situ of the vagina by the brachytherapy as the sole treatment. The brachytherapy was delivered by a remote-controlled afterloading intracavitary radiation system. Results: The mean age of the patients was 62 years. The total dose of absorbed radiation was 36 and 30 Gy that was prescribed at 1.0-cm depth to the vaginal surface in 3 cases and at 40 and 30 Gy that was prescribed at 0.5-cm depth in 10 cases. All patients had vaginal mucosal radiation changes of mild to moderate grade. Three cases that were irradiated to a total dose of 30 Gy at 1.0-cm depth had rectal bleeding and/or macroscopic hematuria. Complaints regarding sexual functioning were not found in this retrospective analysis. All patients remain free of disease after a median follow-up period of 127 months. Conclusion: High dose-rate brachytherapy with a dose prescription at 0.5-cm depth can yield a promising rate of tumor control, with lower associated morbidity than that with a dose prescription at 1.0-cm depth in the treatment of posthysterectomy carcinoma in situ of the vagina. (Am J Obstet Gynecol 2002;187:360-4.)