KEY POINTS
- This retrospective National Cancer Database study included 1,782 patients with surgically staged, node-negative, stage II endometrioid endometrial cancer diagnosed from 2010–2022. Of these, 670 received whole pelvis radiation therapy alone and 1,112 received whole pelvis radiation therapy plus vaginal cuff brachytherapy.
- At a median follow-up of 6.5 years, adding vaginal cuff brachytherapy was associated with improved overall survival on multivariable analysis: hazard ratio 0.68 (95% confidence interval 0.55–0.83; p<0.001).
- The association remained significant after propensity score matching: adjusted hazard ratio 0.61 (95% confidence interval 0.47–0.79; p<0.001).
- Three-year overall survival was 91.7% with whole pelvis radiation therapy plus vaginal cuff brachytherapy versus 88.8% with whole pelvis radiation therapy alone. A three-year landmark analysis also favored the combined approach: hazard ratio 0.70 (95% confidence interval 0.55–0.89; p=0.004).
- The database did not capture recurrence patterns, progression-free survival, treatment-related toxicity, molecular classification, or patient-reported outcomes.
CLINICAL TAKEAWAY
A vaginal cuff brachytherapy boost may provide additional benefit after whole pelvis radiation therapy for carefully selected patients with stage II endometrioid endometrial cancer. However, the observed survival advantage comes from a retrospective database analysis and may reflect residual confounding; prospective evaluation in molecularly defined cohorts is needed before considering the finding practice-changing.