The Case Selection for Vaginal Cuff Brachytherapy in Cervical Cancer Patients after Radical Hysterectomy and External Beam Radiation Therapy

Objective: To Explore the suitable cases for vaginal cuff brachytherapy(VCB) combined with external beam radiation therapy(EBRT) in the postoperative treatment of cervical cancer. MethodsWe retrospectively analyzed the clinical data of 214 postoperative cervical cancer patients who received radiotherapy from January 2008 to December 2015. Among them, 146 patients received postoperative EBRT, 68 received EBRT plus VCB. There was no statistical difference in clinical and pathological characteristics between these two groups. Those who with negative vaginal cuff underwent supplemented 12-18Gy/2-3Fx VCB. Survival analyses were performed using Kaplan-Meier method, and Cox model was used to analyze prognostic factors. ResultsThe median follow-up was 52 months (9-136 months), and 4-year RFS (recurrence-free survival) was 77%. Among them, 58 patients had local or distant recurrences, 29 in pelvic, 8 with metastases to para-aortic or inguinal lymph nodes, 17 with distant metastases and 4 with both local and distant recurrences. The postoperative brachytherapy boost did not improve RFS or OS (overall survival) among the investigated subjects, P =0.77, P =0.99, respectively. Neither it decreased the local relapse in the pelvis or vaginal cuff, P =0.56, P =0.59. Subgroup analyses showed that brachytherapy boost improved RFS in patients who had bulky mass (>4cm) as well as 1) with deep stromal invasion (>50% stromal invasion), P =0.012 or 2) received low EBRT dose (≤ 45Gy), P =0.033, and in patients with deep stromal invasion as well as received low EBRT dose ( P =0.018). ConclusionsWe first proposed the case selection model for postoperative EBRT plus VCB. Brachytherapy boost were considered in the setting of postoperative radiotherapy if the patients had at least 2 out of these following factors: bulky mass, deep stromal invasion and low EBRT dose.