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Original Research

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High-dose-rate intracavitary brachytherapy for non-palpable and non-visible recurrent vaginal stump tumors after hysterectomy

  • M. Sakaguchi1,*,
  • T. Maebayashi1
  • T. Aizawa1
  • N. Ishibashi1
  • T. Saito2

1Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo

2Sonodakai Radiation Oncology Clinic, Adachi-ku, Tokyo (Japan)

DOI: 10.31083/j.ejgo.2020.01.4758 Vol.41,Issue 1,February 2020 pp.54-59

Published: 15 February 2020

*Corresponding Author(s): M. Sakaguchi E-mail:


Purpose: The purpose of this study was to evaluate patients who were treated with high-dose-rate (HDR) intracavitary brachytherapy for non-palpable and non-visible recurrent vaginal stump that occurred after hysterectomy. Materials and Methods: This retrospective study included 11 patients aged 52–81 (median, 61) years. The HDR brachytherapy was performed using a remote after-loading system (RALS). The dose per fraction was planned at mainly 4 Gy/fraction, twice per week, for a total of 32 Gy. Results: CR and PR were diagnosed on cytology or visual examination in nine (82%) patients and in one (9%) patient, respectively. SD was noted in one (9%) patient. Isolated stump recurrence developed in five patients and the three-year LC rate was 53%. There was no severe acute and late toxicity. Conclusion: Local salvage is possible with a three-year LC rate of 53% with regard to non-palpable and non-visible limited vaginal recurrence of gynecological cancer that responds to HDR brachytherapy (4 Gy/fraction, total 32 Gy).


High-dose-rate intracavitary brachytherapy; Recurrent vaginal stump; Hysterectomy; Remote after-loading system; Gynecological cancer.

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M. Sakaguchi,T. Maebayashi,T. Aizawa,N. Ishibashi,T. Saito. High-dose-rate intracavitary brachytherapy for non-palpable and non-visible recurrent vaginal stump tumors after hysterectomy. European Journal of Gynaecological Oncology. 2020. 41(1);54-59.


[1] Landoni F., Maneo A., Colombo A., Placa F., Milani R., Perego P., et al.: “Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer”. Lancet, 1997, 350, 535.

[2] Ingersoll FM.: “Vaginal recurrence of carcinoma of the corpus: Management and prevention”. Am. J. Surg., 1971, 121, 473.

[3] Keys HM., Roberts JA., Brunetto VL., Zaino RJ., Spirtos NM., Bloss JD., et al.: Gynecologic Oncology Group.: “A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2004, 2, 744.

[4] Koss LG., Melaned MR., Daniel WW.: “In situ epidermoid carcinoma of the cervix and vagina following radiotherapy for cervical cancer”. Cancer, 1961, 14, 353.

[5] Thomas G.M., Dembo A.J., Myhr T., Black B., Pringle J.F., Rawlings G.: “Long-term results of concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after surgery”. Int. J. Gynecol Cancer, 1993, 3, 193.

[6] Ito H., Shigematsu N., Kawada T., Kubo A., Isobe K., Hara R., et al.: “Radiotherapy for centrally recurrent cervical cancer of the vaginal stump following hysterectomy”. Gynecol. Oncol., 1997, 67, 154.

[7] Deutsch M., Parsons JA.: “Radiotherapy for carcinoma of the cervix recurrent after surgery”. Cancer, 1974, 34, 2051.

[8] Chyle V., Zagars GK., Wheeler JA., Wheeler JA., Wharton JT., Delclos L.: “Definitive radiotherapy for carcinoma of the vagina: Outcome and prognostic factors”. Int. J. Radiat. Oncol. Biol. Phys., 1996, 35, 891.

[9] MacLeod C., Flower A., Dalrymple C., Atkinson K., Elliott P., Cater J.: “High-dose-rate brachytherapy in the management of highgrade intraepithelial neoplasia of the vagina”. Gynecol. Oncol., 1997, 65, 74.

[10] U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute: “Common Terminology Criteria for Adverse Events (CTCAE). Version 4.0.May 29th, 2009”. Available at: 2010-06-14_QuickReference_8.5x11.pdf

[11] Webb M.J., Symmonds R.E.: “Site of recurrence of cervical cancer after radical hysterectomy”. Am. J. Obstet. Gynecol.,1980, 138, 813.

[12] Huh W.K., Straughn Jr. J.M., Mariani A., Podratz K.C., Havrilesky L.J., Alvarez-Secord A., et al.: “Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multiinstitutional experience”. Int. J. Gynecol. Cancer, 2007, 17, 886.

[13] Evans S.D. Jr., Hilaris B.S., Barber H.R.K.: “External vs interstitial irradiation in unresectable recurrent cancer of the cervix”. Cancer, 1971, 28, 1284.

[14] Potter ME., Alvarez RD., Gay FL., Shingleton HM., Soong S-J., Hatch KD.: “Optimal therapy for pelvic recurrence after radical hysterectomy for early-stage cervical cancer”. Gynecol. Oncol., 1990, 37, 74.

[15] Sutton G.P., Blessing J.A., Mcguire W.P., Patton T., Look K.Y.: “Phase II trial of ifosfamide and mesna in patients with advanced or recurrent squamous carcinoma of the cervix who had never received chemotherapy: A Gynecologic Oncology Group study”. Am J Obstet. Gynecol., 1993, 168, 805.

[16] Jain P., Hunter RD., Livsey JE., Coyle C., Swindell R., Davidson SE.: “Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer”. Clin. Oncol. (R. Coll. Radiol.), 2007, 19, 763.

[17] Haasbeek C.J., Uitterhoeve A.L., van der Velden J., González D.G., Stalpers L.J.: “Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery”. Radiother. Oncol., 2008, 89, 197.

[18] Mandell L.R., Nori D., Hilaris B.: “Recurrent stage I endometrial carcinoma: results of treatment and prognostic factors”. Int. J. Radiat. Oncol. Biol. Phys., 1985, 11, 1103.

[19] Hoekstra C.J., Koper P.C., van Putten W.L.: “Recurrent endometrial adenocarcinoma after surgery alone: prognostic factors and treatment”. Radiother. Oncol., 1993, 27, 164.

[20] Fleisch M.C., Pantke P., Beckmann M.W., Schnuerch H.G., Ackermann R., Grimm M.O., et al.: “Predictors for long-term survival after interdisciplinary salvage surgery for advanced or recurrent gynecologic cancers”. J. Surg. Oncol., 2007, 95, 476.

[21] Guckenberger M., Bachmann J., Wulf J., Mueller G., Krieger T., Baier K., et al.: “Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer”. Radiother. Oncol., 2010, 94, 53.

[22] Ackerman I., Malone S., Thomas G., Franssen E., Balogh J., Dembo A.: “Endometrial carcinoma-relative effectiveness of adjuvant irradiation vs therapy reserved for relapse”. Gynecol. Oncol., 1996, 60, 177.

[23] Creasman WT., Rutledge F.: “Preoperative evaluation of patients with recurrent carcinoma of the cervix”. Gynecol. Oncol., 1972, 1, 111.

[24] Aalders JG., Abeler V., Kolstad P.: “Recurrent adenocarcinoma of the endometrium: A clinical and histopathological study of 379 patients”. Gynecol. Oncol., 1984, 17, 85.

[25] Curran WJ., Whittington R., Peters AJ., Fanning J.: “Vaginal recurrences of endometrial carcinoma: The prognostic value of staging by a primary vaginal carcinoma system”. Int. J. Radiat. Oncol. Biol. Phys., 1988, 15, 803.

[26] Ijaz T., Eifel PJ., Burke T., Oswald MJ.: “Radiation therapy of pelvic recurrence after radical hysterectomy for cervical carcinoma”. Gynecol. Oncol., 1998, 70, 241.

[27] Jobsen J.J., Leer J.W., Cleton F.J., Hermans J.: “Treatment of locoregional recurrence of carcinoma of the cervix by radiotherapy after primary surgery”. Gynecol. Oncol.,1989, 33, 368.

[28] Wylie J., Irwin C., Pintilie M., Levin W., Manchul L., Milosevic M., et al.: “Results of radical radiotherapy for recurrent endometrial cancer”. Gynecol. Oncol., 2000, 77, 66.

[29] Puthawala A., Syed AMN., Nalick DR., McNamara C., Disaia P.: “Integrated external and interstitial radiation therapy for primary carcinoma of the vagina”. Obstet. Gynecol., 1983, 62, 367.

[30] Perez C.A., Grigsby P.W., Castro-Vita H., Lockett M.A.: “Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy”. Int. J. Radiat. Oncol. Biol. Phys., 1995, 32, 1275.

[31] Ogino I., Kitamura T., Okajima H., Matsubara S.: “High-dose-rate intracavitary brachytherapy in the management of cervical and vaginal intraepithelial neoplasia”. Int. J. Radiat. Oncol. Biol. Phys., 1998,40, 881.

[32] Teruya Y., Sakumoto K., Moromizato H., Toita T., Ogawa K., Murayama S., et al.: “High dose–rate intracavitary brachytherapy for carcinoma in situ of the vagina occurring after hysterectomy: A rational prescription of radiation dose”. Am. J. Obstet. Gynecol., 2002, 187, 360.

[33] Smaniotto D., D’Agostino G., Luzi S., Valentini V., Macchia G., Mantini G., et al.: “Concurrent 5-fluorouracil, mitomycin C and radiation with or without brachytherapy in recurrent cervical cancer: a scoring system to predict clinical response and outcome”. Tumori, 2005, 91, 295.

[34] Thigpen T.: “The role of chemotherapy in the management of carcinoma of the cervix”. Cancer J., 2003, 9, 425.

[35] Moore DH., Blessing JA., McQuellon RO., Thaler HT., Cella D., Benda J., et al.: “Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study”. J. Clin. Oncol., 2004, 22, 3113.

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