Internal radiotherapy better than external for quality of life in endometrial cancer patients

Sep 24 2007

Quality of life after treatment for endometrial cancer can be significantly improved by the use of vaginal brachytherapy, where radiotherapy is delivered internally using a vaginal cylinder, the European Cancer Conference (ECCO 14) heard today (Monday September 24).

Dr. Remi Nout, from the clinical oncology department of the Leiden University Medical Centre, Leiden, The Netherlands, said that this quality of life benefit would be an important factor to take into account when balancing the risks and benefits of using vaginal brachytherapy or external beam pelvic radiotherapy after surgery.

“Up till now we have known very little about the quality of life of women with endometrial cancer,” he said, “and how radiotherapy impacts on it. This is the first analysis of data from a randomised trial on the subject.”

Dr. Nout and the PORTEC (post operative radiation therapy for endometrial cancer) team set out to investigate whether vaginal brachytherapy could be as effective as external beam radiotherapy in local control of endometrial cancer, but with fewer side effects and better quality of life. “It is too early for us to know whether the two treatment methods are equally effective,” he said, “but in about a year from now we will be able to tell. When there is little or no difference in effectiveness, we would definitely suggest that vaginal brachytherapy provides the optimal treatment for these patients, because the quality of life benefit is significant.”

This the second study that the PORTEC team has undertaken in the field. PORTEC-1 showed that external beam pelvic radiotherapy significantly reduced the rate of local recurrence, but did not improve patient survival; 26% of patients showed radiotherapy side effects. “Impact of radiotherapy on quality of life, was not evaluated at that time,” said Dr. Nout, “but as a result of the trial, the indications for post-operative radiotherapy were reduced to those patients who showed a significant reduction of local recurrence.”

PORTEC-1 led to the instigation of PORTEC-2, which included a quality of life investigation. The PORTEC-2 trial randomised 427 patients between vaginal brachytherapy and external beam pelvic radiotherapy. Quality of life was analysed in the 345 patients (81%) who returned quality of life questionnaires. Questionnaires were filled in before radiotherapy, after radiotherapy, and 6–12 monthly until five years.

The researchers found that quality of life was at its lowest after surgery, and at that stage did not differ significantly between the two treatment groups. Between 6 and 12 months, quality of life increased gradually in both groups, to reach a plateau at between 12 and 24 months. But from six months onwards, quality of life scores were significantly higher in the brachytherapy group.

“We found that women who had had vaginal brachytherapy reported fewer bowel symptoms like diarrhoea, and less fatigue,” said Dr. Nout, “and that these differences remained significant during further follow-up.” Sexual symptoms, such as vaginal dryness and reduced sexual interest did not vary between the two groups, he said.

“When we come to analyse the main trial results, the combined information on efficacy, side effects and patient-reported quality of life will enable us to decide on optimal treatment for the many women with endometrial carcinoma. Endometrial carcinoma is the most common gynaecologic cancer in Western countries, and because of the ageing population, cases are on the increase. If we find that vaginal brachytherapy is as effective as external radiotherapy, we would expect that brachytherapy would become the standard adjuvant treatment in intermediate risk endometrial cancer,” said Dr. Nout.