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Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists
Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Department of Radiation Oncology, Hospital Clinic Barcelona, Barcelona, Spain; Fonaments Clinics Department, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
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2022 (English)In: Cancers, ISSN 2072-6694, Vol. 14, no 4, article id 906Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There are various society-specific guidelines addressing adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC). However, these recommendations are not uniform. Against this background, clinicians need to make decisions despite gaps between best scientific evidence and clinical practice. We explored factors influencing decision-making for adjuvant BT in clinical routine among experienced European radiation oncologists in the field of gynaecological radiotherapy (RT). We also investigated the dose and technique of BT.

METHODS: Nineteen European experts for gynaecological BT selected by the Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology provided their decision criteria and technique for postoperative RT in EC. The decision criteria were captured and converted into decision trees, and consensus and dissent were evaluated based on the objective consensus methodology.

RESULTS: The decision criteria used by the experts were tumour extension, grading, nodal status, lymphovascular invasion, and cervical stroma/vaginal invasion (yes/no). No expert recommended adjuvant BT for pT1a G1-2 EC without substantial LVSI. Eighty-four percent of experts recommended BT for pT1a G3 EC without substantial LVSI. Up to 74% of experts used adjuvant BT for pT1b LVSI-negative and pT2 G1-2 LVSI-negative disease. For 74-84% of experts, EBRT + BT was the treatment of choice for nodal-positive pT2 disease and for pT3 EC with cervical/vaginal invasion. For all other tumour stages, there was no clear consensus for adjuvant treatment. Four experts already used molecular markers for decision-making. Sixty-five percent of experts recommended fractionation regimens of 3 × 7 Gy or 4 × 5 Gy for BT as monotherapy and 2 × 5 Gy for combination with EBRT. The most commonly used applicator for BT was a vaginal cylinder; 82% recommended image-guided BT.

CONCLUSIONS: There was a clear trend towards adjuvant BT for stage IA G3, stage IB, and stage II G1-2 LVSI-negative EC. Likewise, there was a non-uniform pattern for BT dose prescription but a clear trend towards 3D image-based BT. Finally, molecular characteristics were already used in daily decision-making by some experts under the pretext that upcoming trials will bring more clarity to this topic.

Place, publisher, year, edition, pages
MDPI, 2022. Vol. 14, no 4, article id 906
Keywords [en]
Brachytherapy, decision tree, decision-making, endometrial cancer
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-97697DOI: 10.3390/cancers14040906ISI: 000763943500001PubMedID: 35205653Scopus ID: 2-s2.0-85124277593OAI: oai:DiVA.org:oru-97697DiVA, id: diva2:1641593
Note

Funding agency:

Research Committee of the Kantonsspital St. Gallen 21/01

Available from: 2022-03-02 Created: 2022-03-02 Last updated: 2022-03-16Bibliographically approved

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Hermansson, Ruth S.

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