S87
Brachytherapy - Gynaecology
ESTRO 2026
1 Department of Radiation Oncology, Catalan Institute of Oncology (ICO), Universitat de Barcelona, l'Hospitalet de Llobregat, Spain. 2 Department of Gynecology, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Spain. 3 Department of Radiation Oncology, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain Purpose/Objective: Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. While surgery remains the standard of care for early-stage EC, a significant subset of patients are medically inoperable due to age, obesity, or comorbidities. For these patients, definitive image-guided brachytherapy (IGBT)±external beam radiotherapy (EBRT) offers a curative alternative. However, comparative data with surgery are limited. This study aimed to evaluate whether definitive radiotherapy provides oncological outcomes and toxicity profiles comparable to surgery in early-stage EC and high surgical risk. Material/Methods: A retrospective comparative study was conducted including 72 patients with early-stage EC treated between 2011-2023. 36 medically inoperable patients received definitive IGBT±EBRT and were compared with 36 surgical treated patients (± adjuvant therapy), matched by body mass index (BMI), comorbidities, and FIGO stage. Comorbidity was assessed using the age- adjusted Charlson Comorbidity Index (CCI). Clinical data were obtained from medical records and analyzed using SPSS. A descriptive analysis of baseline characteristics was performed for both groups. Survival and recurrence rates were analyzed using Kaplan-Meier curves and the log-rank test. Results: Median age was 74±9.8 years, and mean BMI 38.1±9.9 kg/m2. In both groups, 94.4% of patients were classified as very high risk (CCI ≥ 5). As shown in table 1, IGBT was delivered using HDR (72%) or PDR (28%), either as exclusive (44%) or combined with EBRT (53%). Mean D90CTV EQD2 was 48.5Gy (range 23.2-72.4) for BT alone and 68.7Gy (range 53.6-84.6) for BT+EBRT. Corresponding D2cc values (BT alone/BT+EBRT) were 26.2/53.4Gy for rectum, 41/51.9Gy for bowel, and 53.1/65.9Gy for bladder. Grade ≥ 3 toxicities occurred in 7 patients, all with D2cc ≥ 70Gy in rectum/sigmoid and ≥ 75Gy in bladder. In the surgery cohort, 58.3% received adjuvant treatment (7/21 IGBT, 6/21 RTE+IGBT, and 7/21 EBRT+IGBT+chemotherapy) (Table 1). Post-treatment complication rates were not significantly different between groups (19.4% vs 27.8%; p=0.45). At 3 months, complete and partial response rates in the RT cohort were 52.8% and 22.2%, respectively. after a median follow-up of 53 months, 5-year cancer-specific survival was 97.1% (radiotherapy) vs 91.4% (surgery; p=0.39), and overall
survival was 72.2% vs 77.8% (p=0.5) (figure 1).
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