Adjuvant radiotherapy in early stage endometrial cancer Radioterapia adjuvante para câncer do endométrio estádio inicial

• Main Authors: Antonio Carlos Zuliani, Aurea Akemi Cairo, Sérgio Carlos Barros Esteves, Carla Cristina dos Santos Watanabe, Maércio de Oliveira Cunha, Gustavo Antonio de Souza
• Format: Article
• Language: English
• Published: Associação Médica Brasileira 2011-08-01
• Series: Revista da Associação Médica Brasileira
• Subjects: Neoplasias dos genitais femininos; radioterapia adjuvante; braquiterapia; neoplasias do endométrio; Genital neoplasms, female; radiotherapy, adjuvant; brachytherapy; endometrial neoplasms
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302011000400019

OBJECTIVE: To compare the rates of overall survival (OS), disease-free survival (DFS) and toxicity in different techniques of postoperative radiotherapy for stage IA endometrioid adenocarcionoma of endometrium, histological grades 1and 2. METHODS: A historical comparison between treatment regimens was performed, and 133 women with a minimum follow-up of 5 years were included. Teletherapy (TELE group), with 22 patients treated from 1988 to 1996, with a 10 MV linear accelerator, average dose 46.2 Gy. Low dose rate brachytherapy (LDRB group) was performed between 1992 and 1995, in 19 women, with an insertion of Cesium 137, at a 60 Gy dose. Fourteen women operated between 1990 and 1996 did not receive radiotherapy (NO RT group). High dose rate brachytherapy was performed in 78 patients (HDRB group), from 1996 to 2004, in five weekly 7 Gy insertions, prescribed at 0.5 cm from the vaginal cylinder. RESULTS: The 5-year disease-free survival was 94.6% for the HDRB group, 94.1% for the LDRB group, 100% for the TELE group and NO RT groups (p = 0.681). The 5-year overall survival was 86.6% for the HDRB group, 89.5% for the LDRB group and 90% for the TELE group and NO RT groups (p = 0.962). Grades 3-5 late toxicity was 5.3% in LDRB group and 27.3% for the TELE group (p &#60; 0.001). CONCLUSION: Patients submitted to adjuvant teletherapy showed very high toxicity, which contraindicates that treatment for those patients. There may be a role for adjuvant HDRB, but randomized controlled trials are still needed to evaluate its benefit.<br>OBJETIVO: Comparar as taxas de sobrevida global (SG), sobrevida livre de doen&#231;a (DFS) e de toxicidade em diferentes t&#233;cnicas de radioterapia p&#243;s-operat&#243;ria para adenocarcionoma endometrioide do endom&#233;trio est&#225;dio IA, graus histol&#243;gicos 1 e 2. M&#233;TODOS: Realizou-se uma compara&#231;&#227;o hist&#243;rica entre regimes de tratamento, incluindo 133 mulheres com seguimento m&#237;nimo de cinco anos. Teleterapia (grupo TELE), com 22 pacientes, de 1988 a 1996, tratadas com acelerador linear 10 MV, dose m&#233;dia de 46,2 Gy. Braquiterapia de baixa taxa de dose (grupo LDRB), realizada entre 1992 e 1995, em 19 mulheres, com uma inser&#231;&#227;o de C&#233;sio 137, dose de 60 Gy. Quatorze mulheres operadas entre 1990 e 1996 n&#227;o receberam radioterapia (grupo NO RT). Braquiterapia de alta taxa de dose foi realizada em 78 pacientes (grupo BATD), 1996-2004, cinco inser&#231;&#245;es semanais de 7 Gy, a 0,5 cm do cilindro vaginal. RESULTADOS: A DFS em cinco anos foi de 94,6% para o grupo BATD, 94,1% para o grupo LDRB, 100% para os grupos TELE e RT (p = 0,681). A sobrevida global em cinco anos foi de 86,6% para o grupo BATD, 89,5% para o grupo LDRB e 90% para os grupos TELE e NO RT (p = 0,962). A toxicidade tardia graus 3-5 foi de 5,3% no grupo LDRB e 27,3% para o grupo TELE (p &#60; 0,001). CONCLUS&#227;O: Pacientes submetidos à teleterapia adjuvante apresentaram toxicidade muito elevada, o que contraindica o tratamento para essas pacientes. Pode haver um papel para a BATD adjuvante, mas estudos controlados randomizados s&#227;o necess&#225;rios para avaliar seu benef&#237;cio.