Acta Oncol Tur.. Ahead of Print: AOT-93206 | DOI: 10.5505/aot.2023.93206

Isolated Vaginal Metastases in Endometrial Cancer and the Role of Adjuvant Brachytherapy

Varol Gülseren¹, Ýlker Çakýr², Gamze Aköz³, Aykut Özcan², Muzaffer Sanci², Zübeyde Emiralioðlu Çakýr², Aykut Özdemir⁴, Pýnar Tuðçe Özer², Kemal Güngördük^5
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, Erciyes University, Kayseri
²Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Ýzmir
³Department of Medical Pathology, Tepecik Education and Research Hospital, Ýzmir
⁴Medipol University, Department of Obstetrics and Gynecology, Division of gynecologic oncology, Ýstanbul
⁵Muðla Sýtký Koçman University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of gynecologic oncology, Muðla

INTRODUCTION: The aim of the study was to investigate the effect of adjuvant vaginal brachytherapy (VBT) after initial surgery on local recurrence, disease-free (DFS) and overall survival (OS) in endometrial cancer (EC).

METHODS: The data of patients diagnosed with EC in Gynecological Oncology Clinic between 1998 and 2021 were analyzed retrospectively. Patients who underwent total hysterectomy with negative surgical margins were included in the study.
RESULTS: Fifty-six patients who were treated for EC and subsequently developed isolated vaginal metastases (IVM) were evaluated. In the treatment of vaginal recurrence, 20 patients were treated with resection + VBT ± external beam radiotherapy (EBRT) ± chemotherapy and 36 patients were treated with VBT + EBRT ± chemotherapy. The 5-year OS rate for patients who received resection + VBT treatment was 78.8%, and 35.8% for patients who received EBRT + VBT treatment (P= 0.023). Recurrence time did not differ significantly depending on whether or not adjuvant VBT was given (P= 0.463). The mean five-year OS rate was 49.4% and 62.5% in patients who did and did not receive VBT, respectively (P= 0.521). As a result of the evaluation of risk factors that may affect OS in patients with IVM according to Cox regression analysis, none of the prognostic factors were found to have a significant effect.
DISCUSSION AND CONCLUSION: It was found that adjuvant vaginal brachytherapy did not affect the local recurrence time and overall survival rate in patients operated for endometrial cancer.

Keywords: Vaginal metastases, Endometrial cancer, Brachytherapy, Lymph node

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Endometriyal Kanserde Ýzole Vajinal Metastazlar ve Adjuvan Brakiterapinin Rolü

Varol Gülseren¹, Ýlker Çakýr², Gamze Aköz³, Aykut Özcan², Muzaffer Sanci², Zübeyde Emiralioðlu Çakýr², Aykut Özdemir⁴, Pýnar Tuðçe Özer², Kemal Güngördük^5
1Erciyes Üniversitesi Týp Fakültesi, Kadýn Hastalýklarý ve Doðum Anabilim dalý, Kayseri
²Tepecik Eðitim ve Araþtýrma Hastanesi, Kadýn Hastalýklarý ve Doðum Anabilim dalý, Ýzmir
³Tepecik Eðitim ve Araþtýrma Hastanesi, Patoloji Anabilim dalý, Ýzmir
⁴Medipol Üniversitesi Týp Fakültesi, Kadýn Hastalýklarý ve Doðum Anabilim dalý, Ýstanbul
⁵Muðla Sýtký Koçman Üniversitesi Týp Fakültesi, Kadýn Hastalýklarý ve Doðum Anabilim dalý, Muðla

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, endometriyal kanserde (EK) ilk cerrahi sonrasý adjuvan vajinal brakiterapinin (VBT) lokal nüks, hastalýksýz (HS) ve toplam saðkalým (TS) üzerindeki etkisini araþtýrmaktý.
YÖNTEM ve GEREÇLER: 1998-2021 yýllarý arasýnda Jinekolojik Onkoloji Kliniðinde EK tanýsý alan hastalarýn verileri retrospektif olarak incelendi. Çalýþmaya cerrahi sýnýrlarý negatif olan total histerektomi yapýlan hastalar dahil edildi.
BULGULAR: EK nedeniyle tedavi edilen ve sonrasýnda izole vajinal metastaz (IVM) geliþen 56 hasta deðerlendirildi. Vajinal nüks tedavisinde 20 hasta rezeksiyon + VBT ± external beam radyoterapi (EBRT) ± kemoterapi ve 36 hasta VBT + EBRT ± kemoterapi ile tedavi edildi. Rezeksiyon + VBT tedavisi alan hastalarda 5 yýllýk TS oraný %78,8, EBRT + VBT tedavisi alan hastalarda ise %35,8 idi (P= 0,023). Nüks süresi, adjuvan VBT verilip verilmemesine baðlý olarak anlamlý farklýlýk göstermedi (P= 0.463). Ortalama beþ yýllýk TS oraný VBT alan ve almayan hastalarda sýrasýyla %49.4 ve %62.5 idi (P= 0.521). IVM'li hastalarda TS'yi etkileyebilecek risk faktörlerinin Cox regresyon analizine göre deðerlendirilmesi sonucunda prognostik faktörlerin hiçbirinin anlamlý etkisi bulunmadý.
TARTIÞMA ve SONUÇ: Adjuvan vajinal brakiterapinin endometrial kanser nedeniyle opere edilen hastalarda lokal nüks süresi ve genel saðkalým oranýný etkilemediði bulundu.

Anahtar Kelimeler: Vajinal metastazlar, Endometrium kanseri, Brakiterapi, Lenf nodu

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