RESUMO
Purpose: To report vaginal cuff brachytherapy (VCB) dosimetry parameters and clinical outcomes of patients with localized endometrial cancer treated with adjuvant high-dose-rate (HDR) brachytherapy using a cobalt-60 (60Co) source. Material and methods: Between 2011 and 2017, we identified patients with endometrial cancer treated with surgery and adjuvant VCB. Dosimetry variables analyzed included D2cc, D1cc, and D0.1cc for organs at risk (OARs) and distance from cylinder surface to 150% and 200% isodose line in vaginal mucosa. Local relapse (LR), regional relapse (RR), distant metastasis (DM), progression-free survival (PFS), and overall survival (OS) were analyzed using Kaplan-Meier, and log-rank test was applied to assess differences between groups. Toxicity evaluation was tested for possible cross-correlation within dosimetric parameters using Pearson r test and stepwise multivariate linear regression. Results: We identified 93 suitable patients. Mean age at diagnosis was 66 years (range, 45-85 years). Most patients had endometrioid adenocarcinoma (61.3%), followed by papillary-serous carcinoma (11.8%). 71% of patients presented with FIGO stage I (35.5% IA and 35.5% IB), 11.8% were stage II, and 17.2% were stage III. Adjuvant external beam radiotherapy (EBRT) (range, 46-50.4 Gy) was used in 53.8% of patients, and adjuvant chemotherapy in 38.7%. Median follow-up was 39 months (range, 5-84 months). Three-year OS and PFS were 87.5% and 85.5%, respectively. LR was seen in 2.2% of cases, RR in 7.5%, and DM in 12.9%. Mean rectum D2cc/D0.1cc were 88.1% and 116%, and mean bladder D2cc/D0.1cc were 79.2% and 103.2%, respectively. The most common acute toxicity was vaginal mucositis (8.9% ≥ G2), and the most frequent chronic toxicity was vaginal stenosis (25.3% ≥ G1). Conclusions: Adjuvant high-dose-rate VCB with 60Co source for patients with endometrial cancer is well tolerated, with clinical and toxicity outcomes comparable to those reported with iridium-192 (192Ir) source.
RESUMO
PURPOSE: To analyze the expression of hypoxia inducible factor 1 alpha (HIF1A) and its correlation with clinical outcome in men with localized prostate cancer (PC) treated with dose escalation radiotherapy (RT) and androgen deprivation (AD). METHODS: Between 1996 and 2004, 129 PC patients who had diagnostic biopsies pre-treatment and 24-36 months following RT were enrolled in this study. Median follow-up was 129 months. Suitable archival diagnostic tissue was obtained from 86 patients. Correlation analysis was done to assess association between HIF1A expression and clinical outcome. RESULTS: HIF1A expression was observed in 25/86 (29%) of diagnostic biopsies, and in 5/14 (36%) of post-RT biopsies. No significant association was noted between HIF1A expression and clinical and treatment parameters. We also failed to show a significant correlation between HIF1A overexpression and outcome. A borderline significant relationship was observed between expression of HIF1A and overall survival (OS) (HR 0.03, p=0.08). CONCLUSION: To our knowledge this is the first study assessing the pattern of change of HIF1A staining in biopsies of patients prior and following treatment. While we did not find significant variations in the expression of HIF1A following radio-hormone therapy, a high HIF1A expression was unexpectedly associated with a borderline improved OS.
