A. Salkeld

Value of Routine Pelvic Examination in the Follow‐Up of Patients Receiving Adjuvant Radiation Therapy for Endometrial Cancer: An Australian Tertiary‐Centre Experience

ABSTRACTIntroductionPelvic examination is a routine component of post‐treatment surveillance for endometrial cancer, supported by global guidelines. However, there is no evidence of oncological or quality‐of‐life benefit, with data suggesting associated discomfort and potential psychological harm. We evaluate the value of routine pelvic examination in follow‐up protocols after adjuvant radiation therapy.MethodsWe retrospectively reviewed all patients receiving adjuvant radiation therapy for endometrial carcinoma across two combined cancer services between January 2017 and December 2022. All stages and histological subtypes were eligible. At least 12 months of documented follow‐up was required. Patients were stratified by FIGO stage (2009 and 2023) and ESGO/ESTRO risk group.ResultsTwo hundred and sixty‐four of 395 patients met inclusion criteria, with a median follow‐up of 34 months. Whilst demographics were widely distributed, the most common features included endometrioid histology (76.5%), FIGO 2023 stage II (48.5%) and ESGO/ESTRO high‐risk (36.7%).Disease recurrence was identified in 41 patients (15.5%). Only four patients had isolated local recurrence, with most also having distant disease at detection. Only three patients had asymptomatic recurrence found on examination (1.1% of cohort), with only one proceeding to salvage therapy (0.4% of cohort). As expected, higher‐risk groups were associated with worse overall survival (p < 0.001).ConclusionsWe found routine pelvic examination following adjuvant radiation therapy for endometrial cancer results in low recurrence detection rates, with salvageable local recurrences being rare. We advocate for the omission of routine pelvic examination from follow‐up protocols for patients receiving adjuvant radiation therapy, with either clinic‐based or telephone‐based follow‐up being offered on a risk‐stratified basis.

Evaluation of plan quality, safety, and toxicity of brachytherapy for locally advanced cervical cancer in an Australian setting following changes in prescription and applicator design

AbstractIntroductionChemoradiotherapy with MRI‐guided brachytherapy boosts is the standard of care for locally advanced cervical cancer. Data from the RetroEMBRACE and EMBRACE I trials provide dose‐response curves for target volumes and OAR. This study evaluated plan quality, safety and toxicity following escalation of the CTV_HR D90 prescription from 80–90 Gy to 85–95 Gy for two different applicator designs.MethodsA retrospective dosimetric plan quality review was undertaken for consecutively treated locally advanced cervical cancer brachytherapy boosts between 2017 and 2022, and the relationships between implant total reference air kerma (TRAK), CTV_HR volume and vaginal dose were investigated. Safety and ≤grade 3 toxicity results were evaluated.ResultsSeventy patients were identified. All patients received a CTV_HR D90 dose >85 Gy and rectum D2cm3 of <75 Gy, while 88.6% of patients received a bladder D2cm3 <90 Gy. Needles were used in 48.6% of patients, and the mean percentage needle TRAK was 38.2%. Increasing the percentage of needle TRAK decreased vaginal TRAK. Sixty‐three patients had more than 12 months of follow‐up (median 27 months). From this cohort, grade 3 or higher toxicity for vaginal, genitourinary, gastrointestinal and fistula events were seen in 3.2%, 1.6%, 0% and 3.2% of patients, respectively.ConclusionIncreased dose prescriptions and a change of applicator design were successfully adopted into an Australian practice. Applicator design and interstitial needle use affect the plan quality and ability to meet OAR dose constraints following target dose escalation. No safety concerns with needle use or dose escalation were identified.