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Objective: This retrospective study was conducted to document the incidence and location of recurrences as well as the rate of side effects following low-dose postoperative high-dose-rate (HDR) brachytherapy in patients with endometrial carcinoma., Methods: From 1987 to 1993, 122 patients with moderate-risk (78) and high-risk (44) endometrial carcinoma underwent adjuvant vaginal irradiation. All patients received three fractions of 7 Gy specified on the surface of the vaginal cylinder., Results: Relapses occurred in 12 (9. 8%) patients on average after 25.6 months. Seven (5.7%) patients had a sole pelvic recurrence; in 2 (1.6%) of those the relapse was located in the vagina only. Three (2.5%) patients had a pelvic relapse combined with distant metastases. Distant metastases alone were diagnosed in 2 (1.6%) patients. A tumor recurrence was diagnosed in 3 of 78 (3.8%) patients with moderate-risk disease and in 9 of 44 (20.5%) patients with high-risk disease. The estimated 5-year relapse-free survival was 94% for patients with moderate-risk and 74% for patients with high-risk tumors (P = 0.004). Neither severe nor chronic complications were noted., Conclusion: Even low doses of HDR brachytherapy seem sufficient for excellent vaginal disease control in moderate-risk disease. In advanced tumors combined radiation therapy is warranted for improved pelvic disease control., (Copyright 1998 Academic Press.)

From 1987 to 1993 21 patients with inoperable endometrial carcinoma of all stages received primary radiation therapy. Patients were treated either with combined external beam radiation (EBRT) and afterloading therapy (AL) or AL alone. AL was delivered in high dose rate (HDR) mode. According to tumor stage 3 to 6 times 7 or 10 Gy were applied to line A, one session per week. Due to changing dose prescriptions total doses for EBRT ranged from 45 to 50.4 Gy. 65% of patients died until the end of follow-up (range 6 to 66 months). 23% died due to progressing tumor or therapeutic sequelae (hemorrhagic colitis), 42% died from intercurrent disease. Only 6 patients are alive, one of them with tumor. After a complete course of radiation therapy there was no in-field relapse. One patient irradiated with curative intention developed paraaortal lymph node metastases. During the observation time of our study most patients died of no tumor related reasons. Primary radiation therapy does effectively control endometrial carcinoma. However, old age, reduced general condition and concomitant disease compromise survival rates after radiation therapy alone.