MRI-guided brachytherapy provided strong cancer control with few serious side effects for people treated for vaginal recurrence of endometrial cancer (EC), according to a retrospective review of 56 patients treated between 2015 and 2023 published recently in Brachytherapy.
These results suggest that modern, image-guided radiation can offer an effective second chance at cure for those whose disease returns after initial surgery. Nearly all patients had endometrioid adenocarcinoma, and the majority initially had low-grade, early-stage disease.
Vaginal recurrence developed a median of 25 months after surgery. At the time of recurrence, 82 percent of cases involved the upper vagina and 95 percent again showed endometrioid histology. Most patients received a combination of external beam pelvic radiation followed by brachytherapy, while three who had received prior pelvic radiation were treated with brachytherapy alone.
“Our study demonstrates that salvage treatment for vaginal recurrence of endometrial cancer with EBRT and MRI-guided intracavitary or interstitial brachytherapy offers excellent local control and DFS with acceptable toxicity,” stated this study’s authors.
Read more about the prognosis of EC
Investigators reported that the two-year local failure rate was 5.9 percent. During the same period, disease-free survival reached 83 percent and overall survival was 94 percent. Eleven patients experienced another recurrence, including four local failures, three regional relapses and seven distant metastases. Six patients died, all after cancer returned. For patients, these numbers reflect a high likelihood of controlling the disease in the pelvis and maintaining quality of life.
Brachytherapy was delivered either with an interstitial technique using a perineal template (70 percent of patients) or with an intracavitary multichannel vaginal applicator (30 percent). No local failures occurred in the intracavitary group. Most patients received between two and four treatment fractions, with doses carefully guided by MRI to protect nearby organs such as the bladder, rectum and bowel.
Importantly, no grade 3 or higher late toxicities were seen. The few side effects that did occur were mild to moderate, including one genitourinary and six vaginal toxicities, all grade 2 or lower. Patients who had previously received radiation were more likely to experience vaginal irritation, but rates remained manageable.
For patients facing a stressful and frightening recurrence, the study underscores that salvage radiation using MRI guidance can offer both reassurance and hope. High rates of tumor control, preservation of organ function and minimal severe complications mean many can continue daily life with confidence while maintaining long-term survival prospects.
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