S64
Brachytherapy - Gynaecology
ESTRO 2026
Results: A total of 27 patients (median age 54, range 40-80) with vaginal cuff recurrences, who were naïve to prior radiotherapy, were included in this study. The median time to relapse after surgery was 26 months (range 9- 329 months). Most frequent primary tumour was cervix cancer (16 patients), followed by 11 endometrial cancers. Four patients with positive nodes received a simultaneous integrated boost (total dose EQD2 60–65 Gy). 19 patients received additional cisplatin chemotherapy. The median follow-up duration was 17 months (3-73 months). The two-year actuarial LC, MFS, OS and CSS rates were 100%, 77.8%, 93% and 93%, respectively. Acute grade 2 gastrointestinal and skin toxicity was recorded in 2 patients, while late G3 toxicity (vaginal stenosis) occurred in one patient. Conclusion: This retrospective series indicates that the use of IG- IRT as a boost following external beam radiotherapy for vaginal cuff recurrences is both an effective and safe treatment option, resulting in excellent local control and a favourable toxicity profile. Keywords: vaginal recurrence; interventional radiotherapy; IMAGE-GUIDED INTERVENTIONAL RADIOTHERAPY (MODERN BRACHYTHERAPY) FOR THE TREATMENT OF HIGH-GRADE VAGINAL INTRAEPITHELIAL CANCER Valentina Lancellotta 1 , Maria Concetta La Milia 1 , Gabriella Macchia 2 , Bruno Fionda 1 , Elisa Placidi 1 , Enrico Rosa 1 , Pierpaolo Dragonetti 1 , Lucia Di Maio 1 , Simona Maria Fragomeni 3 , Rosa Autorino 1 , Giorgia Garganese 3 , Alex Federico 3 , Maria Antonietta Gambacorta 1 , Luca Tagliferri 1 1 Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Rome, Italy. 2 Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy. 3 Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS,, Rome, Italy Purpose/Objective: Vaginal intraepithelial neoplasia (VaIN) is a rare condition that poses diagnostic and management challenges and carries a significant risk of progression to invasive cancer. Usually, image-guided interventional radiotherapy (IG-IRT, also called brachytherapy) has a high overall success rate but it is reserved for poor surgical candidates, having multifocal disease, and with failed prior treatments (1). Digital Poster 2310
This study aims to present the outcomes of a series of high-grade vaginal intraepithelial cancer (VAIN 3)
treated with IG-IRT. Material/Methods:
We retrospectively analysed patients with VAIN3 who received IG-IRT with curative intent between January 2019 and May 2025. OncentraBrachy treatment planning system and a Flexitron (Elekta, Stockholm, Sweden) after loading machine with a 192-Ir source was used for IG-IRT treatment. The IG-IRT total dose was 40 Gy over eight high dose rate (HDR) fractions in order to achieve 60Gy EQD2 α / β 10 to the clinical target volume (CTV). The exact length of the vagina included in the treatment field was decided by the site and the number of lesions. The primary study endpoint was the local control (LC), while secondary endpoints included rate and severity of acute and late toxicities. Actuarial outcomes were analysed using the Kaplan- Meier method. Statistical analysis was carried out using SPSS statistical software (IBM Corp. Version 20.0. Armonk, NY). Results: A total of 10 patients with high-grade vaginal intraepithelial cancer, who were naïve to prior radiotherapy, were included in this study. The median follow-up duration was 17 months (5-70 months). The one-year actuarial LC and OS were 100% and 100%, respectively. No acute toxicity was recorded in all patients, while late G2 toxicity (vaginal stenosis 1 and atrophy 4) occurred in four patients. Conclusion: This retrospective series indicates that the use of IG- IRT as exclusive treatment for high-grade vaginal intraepithelial cancer is both an effective and safe treatment option, resulting in excellent local control and an acceptable toxicity profile. Keywords: HIGH-GRADE VAGINAL INTRAEPITHELIAL CANCER References: Kesic V, Carcopino X, Preti M, et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia. Int J Gynecol Cancer. 2023 Apr 3;33(4):446-461. doi: 10.1136/ijgc-2022-004213.
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