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Journal Article Epublish 9 citations

PubMed: 35205653 DOI: 10.3390/cancers14040906

Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists.

Cancers (Basel) 14(4)

Authors: Markus Glatzer, Kari Tanderup, Angeles Rovirosa, Lars Fokdal, Claudia Ordeanu, Luca Tagliaferri, Cyrus Chargari, Vratislav Strnad, Johannes Athanasios Dimopoulos, Barbara Šegedin, Rachel Cooper, Esten Søndrol Nakken, Primoz Petric, Elzbieta van der Steen-Banasik, Kristina Lössl, Ina M Jürgenliemk-Schulz, Peter Niehoff, Ruth S Hermansson, Remi A Nout, Paul Martin Putora, Ludwig Plasswilm, Nikolaos Tselis

Affiliations

  • Department of Radiation Oncology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
  • Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark.
  • Department of Radiation Oncology, Hospital Clinic Barcelona, 08036 Barcelona, Spain.
  • Fonaments Clinics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain.
  • Department of Radiotherapy, Institute of Oncology "Prof. Dr. Ion Chiricuta", 400015 Cluj-Napoca, Romania.
  • Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy.
  • Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, 94805 Paris, France.
  • Department of Radiation Oncology, University Hospital Erlangen, 91054 Erlangen, Germany.
  • Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.
  • Department of Radiation Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
  • Radiotherapy Research Group, Leeds Cancer Centre, St. Jame's University Hospital, Leeds LS9 7TF, UK.
  • Department of Oncology, Oslo University Hospital, 0424 Oslo, Norway.
  • Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland.
  • Department of Radiotherapy, Radiotherapiegroep Arnhem, 6815 AD Arnhem, The Netherlands.
  • Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3041 Bern, Switzerland.
  • Department of Radiation Oncology, Cancer Center, University Medical Center Utrecht, 3584 AB Utrecht, The Netherlands.
  • Department of Radiation Oncology, Sana Klinikum Offenbach GmbH, 63069 Offenbach, Germany.
  • Department of Oncology, Faculty of Medicine and Health, Örebro University, 70 185 Örebro, Sweden.
  • Department of Radiotherapy, Erasmus MC Cancer Institute, 3000 CA Rotterdam, The Netherlands.
  • Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Goethe Universität, 60590 Frankfurt, Germany.

Abstract

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.

MeSH

Brachytherapy, Decision Making, Endometrial Neoplasms, Radiation Oncologists

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