According to a recent study presented during the 3rd ESTRO Forum in Barcelona, Spain, women with early stage endometrial cancer who are inoperable tend to live longer when treated with brachytherapy with or without external beam radiation.
Brachytherapy is a type of internal radiotherapy in which a radioactive source is placed in or close to the tumor. It has been used to treat inoperable endometrial cancer, but there is no randomized evidence that scientifically supports this approach. Study author Dr. Sahaja Acharya explained the conference: “To our knowledge, this is the first population-based study to compare outcomes for patients who received brachytherapy, with or without external beam radiation, to those who did not receive brachytherapy and were treated with external beam radiation alone.”
Dr. Acharya and her team assessed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database, which evaluated 460 American women who received treatment between 1998 and 2011 with radiation therapy to address their inoperable stage 1 endometrial cancer.
The majority of times, early stage endometrial cancer can be easily removed through surgery, resulting in favorable prognosis. However, there are cases of inoperable cancers due to other medical conditions that can transform the operation into a risky procedure for the patient; to address these specific cases, radiotherapy is the only possible approach.
In this clinical study, 56.5 percent (260) of the total 460 women received external beam radiation treatment alone and 43.5 percent (200) were treated with brachytherapy, with or without external beam radiation.
Brachytherapy was, as observed by researchers, associated with improved survival rates: 60 percent of women who had been treated with brachytherapy were alive 3 years post-treatment in comparison to 47 percent of women who were treated with external beam radiation only. The team compared those who received brachytherapy with those who did not based on the year of diagnosis, age and grade. Results kept showing a survival benefit for patients who underwent brachytherapy.
Importantly, deaths as a consequence of endometrial cancer decreased after 3 years among women who received brachytherapy: 18 percent of those treated with brachytherapy died versus 26 percent of women who did not receive brachytherapy.
“These patients have many other medical problems and not only die from endometrial cancer, but also from causes other than cancer, such as cardiovascular disease,” Dr. Acharya explained. “These findings show that brachytherapy is associated independently with an improved overall survival three years after diagnosis for women with inoperable stage 1 endometrial cancer. All these patients should be considered for brachytherapy and it should be administered when feasible.”
There is an association between improved survival and brachytherapy treatment, however the study was incapable of showing that brachytherapy is the ultimate reason behind extended survival rates; a randomized controlled trial would be necessary. Dr. Acharya added at the conference: “It is also important to recognise the limitations of using the SEER data. Although the SEER registry represents 28% of the US population, treatment information on radiation dose, radiation treatment volume, brachytherapy technique and external beam radiation technique is not available. There is also no information on treatment-related toxicity. Therefore, one cannot draw conclusions on the efficacy or toxicity of particular radiation doses.”
“In our ageing population, we are confronted progressively more often with patients who have a malignant disease but who are unfit for receiving the most appropriate medical treatment. However, often we have valuable alternatives, like radiation therapy instead of surgery for patients with endometrial cancer. This study highlights the importance of selecting the most effective treatment, even when the burden might seem higher compared to, at first sight, a more gentle approach. In the case of patients with early stage endometrial cancer who cannot be operated on, brachytherapy should be part of the treatment approach, providing, of course, that this is technically feasible,” commented Philip Poortmans, President of ESTRO.