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For endometrial cancer of high-intermediate risk, brachytherapy to the top of the vagina alone controlled the disease as well as radiotherapy to the whole pelvis, with fewer bowel side effects and better quality of life.
Phase 3 trial of 427 women with stage I to IIA endometrial carcinoma with high-intermediate-risk features randomised to vaginal brachytherapy or external beam pelvic radiotherapy.
Five-year vaginal recurrence was 1.8 versus 1.6 percent, locoregional relapse 5.1 versus 2.1 percent (not significant), and overall survival 84.8 versus 79.6 percent, with markedly less gastrointestinal toxicity after brachytherapy.
Vaginal brachytherapy is the standard adjuvant treatment for high-intermediate-risk endometrial cancer, with pelvic radiotherapy reserved for higher-risk features such as substantial lymphovascular invasion or p53 abnormality.