Comparison of outcomes in early-stage uterine clear cell carcinoma and serous carcinoma

Purpose

The treatment paradigm for uterine clear cell carcinoma is often linked to serous carcinoma. This study compares oncologic outcomes between women with uterine clear cell and serous carcinoma.

Vaginal vault brachytherapy as sole postoperative treatment for low-risk endometrial cancer

PURPOSE: To evaluate the efficacy and side effect profile of adjuvant vaginal vault brachytherapy alone after hysterectomy in Stage I endometrial carcinoma. METHODS AND MATERIALS: Between 23/11/1992 and 16/05/2005, a total of 173 patients with early endometrial carcinoma treated with vaginal vault brachytherapy alone postoperatively were identified. Patients were treated using a single-line source vaginal stump applicator (Varian Medical Systems) to deliver a dose of 5.5 Gy per fraction at a depth of 5mm from the applicator surface. A total of four fractions were delivered treating twice a week giving an overall treatment time of 10 days to deliver the total dose of 22 Gy in four fractions. RESULTS: There were 19 deaths in this series, 6 (3.5%) from disseminated endometrial cancer and 13 (7.5%) from unrelated causes. High-risk features of Stage 1C, Grade G3, or clear cell histology were present in all 6 patients who developed metastatic disease. One patient developed a local recurrence alone, which was salvaged with external beam pelvic radiotherapy. The low-risk group defined by Stage 1B and G1 or G2 did not develop distant relapse in this series. Late morbidity was rare except for vaginal stenosis seen in 13%. CONCLUSIONS: This series confirms that vaginal vault brachytherapy is associated with a high rate of pelvic control and survival after simple hysterectomy for low- and intermediate-risk endometrial cancer with minimal toxicity.     

The management of inoperable Stage I endometrial cancer using intracavitary brachytherapy alone: A 20-year institutional review

ObjectiveTo review our institution's results with primary low dose rate (LDR) intracavitary brachytherapy using Heyman's capsules for medically inoperable cancer of the endometrium.MethodsThe study was a retrospective review of inoperable early-stage endometrial cancer patients at the Cross Cancer Institute in Edmonton, Canada, treated with primary radiotherapy from January 10, 1986 to July 17, 2006. Forty-four patients with International Federation of Gynaecology and Obstetrics (FIGO) clinical Stage I disease were included in the study. Kaplan–Meier survival analysis was performed to obtain estimates of overall survival (OS), disease-free survival, and disease-specific survival (DSS). Tumor grade was assessed as a potential predictor of OS by comparing survival curves using a log-rank test.ResultsThe median OS time was 75.5 months (95% confidence interval 55.6–95.3 months). For the entire group, the 5- and 10-year OS was 60.5% and 24.0%, respectively. The 5- and 10-year DSS was 87.7% and 79.7%, respectively. For a subset treated as planned, the 5- and 10-year OS was 54.5% and 34.5%, respectively. The 5- and 10-year DSS was 83.0% and 76.4%, respectively. When stratified by grade, trends in survival analysis are inversely related to grade. Both the trend analysis and the log-rank test were statistically significant at a p < 0.05 level.ConclusionsOur experience with LDR brachytherapy for the treatment of Stage I endometrial cancer is comparable to surgical treatment and to results reported in the literature for high dose rate brachytherapy. Further study that would help define the indications for a primary radiotherapeutic approach in early-stage endometrial cancer may lower current thresholds for recommending primary radiotherapy versus surgery.     

Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma

PurposeDefinitive radiotherapy is a viable option for medically inoperable patients with early stage endometrial cancer. We present our experience using image-based brachytherapy (BT).Methods and MaterialsPatients with medically inoperable clinical Stage I endometrial adenocarcinoma received definitive BT with or without external beam radiotherapy. High-dose-rate BT was delivered using MRI- or CT-based planning for each fraction. For patients with an MRI, gross tumor volume (GTV) was contoured although dose was still prescribed to the clinical treatment volume (CTV), including the entire uterus, cervix, and upper 1–2 cm of vagina. Equivalent 2 Gy doses (EQD₂) were calculated.ResultsThirty-eight patients were treated from 2007 to 2013, 20 receiving BT alone with a median dose of 37.5 Gy in five to six fractions. For combined therapy, median external beam and BT doses were 45 and 25 Gy in four to five fractions. With 15-month median followup, the 2-year actuarial local control and overall survival were 90.6% and 94.4%. No Grade 2–5 late toxicities were observed. Mean CTV D₉₀ EQD₂ for BT alone and combined therapy was 48.6 ± 5.6 and 72.4 ± 6.0 Gy, whereas mean GTV D₉₀ EQD₂ was 172.3 ± 59.6 and 138.0 ± 64.6 Gy.ConclusionsImage-based BT is feasible for medically inoperable early stage endometrial cancer with excellent early results. Despite low CTV doses, high doses delivered to GTV with BT likely accounts for high local control. Endometrial cancer guidelines for image-based planning are needed to define target volumes based on risk with differential dose delivery.     

Daily online adaptive magnetic resonance image (MRI) guided stereotactic body radiation therapy for primary renal cell cancer

Stereotactic body radiotherapy (SBRT) has demonstrated promising outcomes for patients with early-stage, medically inoperable, primary renal cell carcinoma (RCC) in large multi-institutional studies and prospective clinical trials. The traditional approach used in these studies consisted of a CT-based planning approach for target and organ-at-risk (OAR) volume delineation, treatment planning, and daily treatment delivery. Alternatively, MRI-based approaches using daily online adaptive radiotherapy have multiple advantages to improve treatment outcomes: (1) more accurate delineation of the target volume and OAR volumes with improved soft tissue visualization; (2) gated beam delivery with biofeedback from the patient; and (3) potential for daily plan adaptation due to changes in anatomy to improve target coverage, reduce dose to OARs, or both. The workflow, treatment planning principles, and aspects of treatment delivery specific to this technology are outlined using a case example of a patient with an early-stage RCC of the right kidney treated with MRI-guided SBRT using daily adaptive treatment to a dose of 42 Gy in 3 fractions.     

Vaginal brachytherapy alone for patients with Stage II endometrial cancer with inner half cervical stromal invasion

PurposeThe purpose of this study was to review outcomes of women with Stage II endometrial carcinoma with inner half cervical stromal invasion treated with adjuvant vaginal brachytherapy (VB) alone.Methods and MaterialsA single-institution retrospective chart review identified consecutive patients with Stage II endometrial cancer and inner half cervical stromal invasion treated with VB alone from 2011 to 2015. Patients who received chemotherapy or external beam radiotherapy were excluded. Patient and disease characteristics were collected. Association between variables and outcomes were assessed using Fisher's exact or Wilcoxon rank sum test.ResultsFifty-seven patients were identified over 5 years with a median followup of 46.8 months. Carcinoma was endometrioid Grade 1 (43.9%), 2 (36.8%), 3 (5.3%), or serous (14.0%). Depth of myometrial invasion was inner half in 75.4%. Lymphovascular invasion was seen in 28.1%, and lymph node assessment was performed in 43.9% of patients. The median depth of cervical stromal invasion was 1.25 mm (n = 48 patients). The median percentage of the cervical stromal wall invaded by tumor (obtained in 40 patients) was 16.7%. Seven (12.3%) patients recurred at a median of 16.9 months. Five-year estimates of progression-free survival and overall survival were 81.5% and 78.5%, respectively. The only factor associated with recurrence, progression-free survival or overall survival on bivariate analysis was high-grade (Grade 3 or serous) disease (p = 0.031).ConclusionsVB alone can be considered for Stage II patients with inner half cervical stromal invasion and Grade 1–2 disease. Systemic therapy may be required for patients with Grade 3 and serous histology as 75% (3/4) of these recurrences were outside the pelvis.     

What is appropriate target delineation for MRI-based brachytherapy for medically inoperable endometrial cancer?

PURPOSEFor medically inoperable endometrial cancer (MIEC), the volumetric target of image-guided brachytherapy (IGBT) techniques is not well established. We propose a high-risk CTV (HRCTV) concept and report associated rates of local control and toxicity.METHODS AND MATERIALSFor all MIEC patients receiving definitive external beam radiotherapy (EBRT) followed by MRI-based IGBT at a single institution, BT dose was prescribed to HRCTV defined as GTV plus endometrial cavity with a planning goal of a summed EQD2 D90 of ≥85 Gy. Freedom from local progression (FFLP) and overall survival (OS) were estimated via Kaplan Meier method.RESULTSThirty two MIEC patients received EBRT followed by MRI-based IGBT between December 2015 and August 2020. Median follow up was 19.8 months. A total of 75% of patients had FIGO stage I/II disease, 56% endometrioid histology, and 50% grade 3 disease. OS was 73.6% (95% CI 57.8%–89.3%) at 12 months and 65.8% (95% CI 48.4%–83.2%) at 24 months. FFLP was 93.8% (95% CI 85.3%–100%) at 12 months and 88.8% (95% CI 86.6%–91.0%) at 24 months. 23 (72%) patients experienced no RT-related toxicity, while 2 of 32 patients (6%) experienced late grade 3+ toxicities (grade 3 refractory vomiting; grade 5 GI bleed secondary to RT-induced proctitis).CONCLUSIONSPatients with MIEC receiving definitive EBRT followed by MRI-based IGBT prescribed to the MRI-defined HRCTV demonstrated favorable long-term local control with an acceptable toxicity profile.     

Upfront radiotherapy with brachytherapy for medically inoperable and unresectable patients with high-risk endometrial cancer

ObjectivesComprehensive surgery with adjuvant therapy is standard of care for high-risk endometrial cancers, whereas upfront radiotherapy with brachytherapy is indicated for inoperable/unresectable patients, irrespective of risk. We evaluated outcomes for inoperable/unresectable patients with high-risk endometrial cancer (HREC: stage III and/or grade 3) and low-risk endometrial cancer (LREC: stage I/II and grade 1/2) treated with upfront radiotherapy.MethodsTwenty-nine patients with inoperable/unresectable endometrial cancer were treated with upfront radiotherapy at an academic medical center from 2012 to 2019. Cancer-specific survival (CSS), overall survival (OS), and recurrence rates between patients with HREC and LREC were compared.ResultsMedian follow-up was 17.0 months (range 3.7–54.0). Twenty cancers were stage I + II and nine were stage III. Twenty-one cancers were grade 1 + 2 and eight were grade 3. Thirteen patients (45%) had HREC. Twenty-five patients received radiotherapy/chemoradiotherapy for primary treatment, while 4 patients received chemoradiotherapy before surgery. All patients underwent high dose rate brachytherapy (HDR) with 7 receiving HDR alone and 22 receiving external beam radiation and HDR. Two-year CSS was 100% for both HREC and LREC patients (log-rank p = 0.32). There was no OS difference between HREC and LREC patients (2-year: 73% vs. 77%; log-rank p = 0.33). Four HREC and 1 LREC patients recurred with one local recurrence in each group. There were no acute grade ≥3 and two late grade ≥3 gastrointestinal/genitourinary toxicities.ConclusionsUpfront radiotherapy for inoperable/unresectable HREC patients was well tolerated with high local control and CSS rates. Upfront radiotherapy with brachytherapy remains important even for high-risk inoperable and unresectable endometrial cancer patients.     

Stage IV endometrial carcinoma: a 10 year review of patients.

Stage IV endometrial cancer is uncommon, often occurs in elderly patients and has a poor prognosis, which makes the choice of treatment difficult. 18 patients with stage IV endometrial cancer presenting over a 10 year period, between 1987 and 1997, were reviewed with regard to mode of treatment and response. The mean age was 65 years. Five had disease confined to the pelvis and 13 had extra pelvic disease. 15 of 18 patients had a total abdominal hysterectomy (TAH). One patient received radiotherapy alone and five received post-operative radiotherapy. Overall freedom from pelvic symptoms was achieved in seven of 18 patients. All seven had undergone TAH and two had received post-operative radiotherapy. Progestogens were given to 13 patients. Six received progestogens alone, without radiotherapy or chemotherapy. Of these, two responded, one for 9 months and one with verified lung metastases, who had a complete response, is still alive at 6.5 years. Eight patients received chemotherapy, with single agent cisplatin or carboplatin AUC 6. Three patients responded, one for 4.5 years. The overall median survival was 12 months from diagnosis. Actuarial 5 year survival was 15% (CI 3-36). There was no significant survival difference for, hormone therapy or chemotherapy. Stage IV endometrial cancer has a poor prognosis but durable response can be achieved in some patients.     

Canadian Association of Radiologists: treatment results in 2719 patients with carcinoma of the endometrium 1973-1977

A retrospective analysis of treatment results in 2719 patients with endometrial cancer registered at 14 Canadian cancer centres in the 5-year period 1973-1977 was performed. The patients had a median age of 61.5 years and an overall 5-year survival of 78.5% (relative survival rate 86.0%). After preoperative radiotherapy the number of poorly differentiated and deeply invasive lesions seen at hysterectomy was reduced. The 1063 patients with stage I cancer treated with preoperative radiotherapy had a 5-year survival rate of 85.9% and a 5-year actuarial complication rate of 3.8%. The 359 patients with stage I cancer who had a hysterectomy followed by radiotherapy had a survival rate of 81.6% and a complication rate of 11.9%. Both differences are statistically significant (p less than 0.05 and p less than 0.0001 respectively). External beam radiotherapy was associated with the majority of severe complications. The actuarial complication rate in patients treated with postoperative radiotherapy was 9.8%, but when radiotherapy had been given before hysterectomy, it was 4.4% (p less than 0.001). We conclude from this study that when adjuvant radiotherapy is indicated, in the (generally elderly) patient with endometrial cancer it is safer to give preoperative rather than postoperative treatment. This largely avoids administering external beam radiotherapy with its potential high complication rate and no benefit in extended survival.     

Radiofrequency ablation of pulmonary tumors

The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of solid tumors. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. RF ablation is accepted as the best therapeutic choice for patients with early-stage hepatocellular carcinoma when liver transplantation or surgical resection are not suitable options and is considered as a viable alternate to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Recently, RF ablation has been demonstrated to be a safe and valuable treatment option for patients with unresectable or medically inoperable lung malignancies. Resection should remain the standard therapy for non-small cell lung cancer (NSCLC) but RF ablation may be better than conventional external-beam radiation for the treatment of the high-risk individual with NSCLC. Initial favourable outcomes encourage combining radiotherapy and RF ablation, especially for treating larger tumors. In the setting of colorectal cancer lung metastases, survival rates provided by RF ablation in selected patients, are substantially higher than those obtained with any chemotherapy regimens and provide indirect evidence that RF ablation therapy improves survival in patients with limited lung metastatic disease.     

Stage IB cervical carcinoma: a clinical audit.

All patients with FIGO Stage IB cervical cancer registered with the Department of Clinical Oncology at the Western General Hospital, Edinburgh, during the 6 years from 1979 to 1984 have been reviewed, as part of a continuing programme of clinical audit. Of the 140 patients with Stage IB disease, 68 (49%) were treated by primary surgery of whom 44 (31%) also received adjuvant radiotherapy. Radical radiotherapy was the definitive treatment for 69 patients (49%). Three patients (2%) were not treated with curative intent. The crude 5-year survival rate for all cases was 72% and the cause-specific 5-year survival rate was 78%. Local tumour control at 5 years was 72%. There was no significant difference in outcome between the surgically treated and irradiated groups of patients. Age, histology and nodal status did not influence outcome. Irradiated patients with bulky tumours fared significantly worse than the other patients who received radical radiotherapy. Multivariate analysis of all patients revealed no significant independent prognostic variables. Primary surgery appears to confer no benefit over radical radiotherapy in terms of either survival or local control. Treatment-related late bladder and bowel morbidity was, however, significantly worse in irradiated patients.     

Endoluminal high-dose-rate brachytherapy for locally recurrent or persistent esophageal cancer

PurposeManagement of locally recurrent or persistent esophageal cancer (EC) after standard chemoradiation is challenging. This study updates our experience of treating medically inoperable EC patients with endoluminal high-dose-rate brachytherapy (EHDRBT) including the patients treated with a novel multiballoon channel centering esophageal applicator.Methods and MaterialsThirty-three consecutive patients with early-stage primary (n = 7), posttreatment persistent (n = 7), and recurrent (n = 19) EC treated with EHDRBT at our institution were included. Median dose and treatment lengths were 14 Gy (range 10–17.5 Gy) and 6 cm (3.5–9.0 cm), respectively. Endoscopy and biopsy were performed 3 months after EHDRBT and then every 3–6 months thereafter.ResultsMedian followup was 17.4 months (range 5.0–88.3). Grade 1 and 2 toxicities were observed in 13 (44.8%) and 11 (37.9%) patients, respectively. Grade 3 toxicity (tracheoesophageal fistula) was observed in 1 patient who had previously received two courses of external beam radiotherapy as well as a stent insertion. Median overall survival (OS) for entire cohort was 20.9 months, and 1-year OS was 78%. Complete response was achieved in 58.6% of patients with median time to failure and 1-year disease-free survival of 10.3 months (range 5.4–28.2) and 27%, respectively.ConclusionsFor medically inoperable patients with early-stage primary or local posttreatment residual or recurrent EC, EHDRBT is a well-tolerated treatment option with minimal Grade ≥3 toxicity. Brachytherapy in our hands continues to be a safe treatment option. Although 58.6% of patients achieved a complete response and the OS of this cohort is relatively good, long-term local control and cure remains a challenge.     

Radiotherapy in elderly patients with inoperable esophageal cancer

Background

Radiation oncologists increasingly face elderly cancer patients impaired by comorbidities and reduced performance status. As less data are available for this particular group of patients, the aim of the study was to assess the prognosis of inoperable esophageal cancer patients ≥?70?years undergoing definitive radiotherapy or radiochemotherapy.

Patients and treatment protocol

Patients aged ≥?70 with inoperable carcinoma of the esophagus undergoing definitive radio(chemo)therapy between 1995 and 2006 at the University of Cologne were included retrospectively. Maximal total dose of radiotherapy administered was 63?Gy (5?×?1.8?Gy/week). Chemotherapy consisted of cisplatin (20?mg/m² on days 1–5 and days 29–33) and 5-fluorouracil (650–1,000?mg/m² on days 1–5 and days 29–33). Efficacy was compared with a cohort of 152?patients <?70?years treated with the same protocol during the same time period.

Results

A total of 51?patients aged ?≥?70 with inoperable cancer of the esophagus undergoing definitive therapy were identified (stage I/II 23.5%, stage III 56.9%, stage IV 9.8%; squamous cell carcinoma 74.5%, adenocarcinoma 25.5%). While 15?patients (29.4%) received combined radiochemotherapy (RCT), 40?patients (70.6%) were treated with radiotherapy alone (RT). Median progression-free survival (PFS) was 9.5?months; median overall survival (OS) was 13.9?months. Patients treated with RCT had a 2-year OS rate of 53.3% compared with 16.7% for RT patients (p?=?0.039). The 2-year OS for clinically lymph node negative patients was 38.5% compared with 21.2% for lymph node positive patients (p?=?0.072). Median OS was not significantly different between patients ≥?70?years versus the patient cohort (n?=?152) aged <?70?years (13.9 vs. 7.2?months, p?=?0.072) but PFS showed a significant difference (4.9 vs. 9.5?months, p?=?0.026) in favor of the >?70?years group.

Conclusion

Prognosis in elderly patients with inoperable esophageal cancer undergoing definitive radiotherapy/radiochemotherapy is limited, although it is not inferior to patients <?70?years.     

Postoperative versus definitive chemoradiation in early-stage anal cancer

Background and purpose

The goal of the present study was to comparatively assess the results of definitive chemoradiation (CRT) with or without previous macroscopically complete resection in patients with early-stage node-negative (T1–2 N0) anal carcinoma.

Patients and methods

A total of 20?patients with T1–2 N0 anal carcinoma who received radiotherapy (RT) with or without chemotherapy following incidental R0/1 tumor resection (S/CRT group) were selected. These were matched to 20?comparable patients who underwent definitive chemoradiation without previous surgery (CRT group). Major objectives of this analysis were treatment outcomes in terms of locoregional tumor control (LRC), overall survival (OS), colostomy-free survival, and toxicity.

Results

Patients treated postoperatively received significantly lower RT doses (median 54.0?Gy vs. 59.7?Gy; p?Conclusion This matched-pair comparison of incidental R0/1 resection plus dose-reduced CRT with standard definitive CRT of early-stage anal cancer shows similar treatment results. Thus, dose-reduced RT with or without chemotherapy may be considered in R0/1 resected patients with T1–2 N0 anal carcinoma.     

The relative radioresponsiveness of small cell lung cancer

Sixty-eight irradiated patients with one of the four major histological cell types of lung carcinoma were analyzed to provide additional evidence on the known radioresponsiveness of small (oat) cell lung cancer. The majority of evaluable subjects obtained symptom(s) relief irrespective of histology. Relatively higher complete objective response rates and longer average periods of survival were observed in individuals with undifferentiated large or small cell lung carcinoma (SCLC) than in those with squamous cell carcinoma or adenocarcinoma. Three of six long-term survivors were from the SCLC patient group. It was concluded that radiotherapy response is a predictive factor for survival and that SCLC is not radioresistant.     

Factors influencing treatment results of definitive radiotherapy following transurethral surgery for muscle-invasive bladder cancer]

PURPOSE: To determine the prognostic factors influencing the outcome of bladder cancer patients treated with definitive radiotherapy following transurethral tumor resection (TURBT). MATERIALS AND METHODS: From March 1977 through August 1991, 83 patients with muscle-invasive bladder cancer were treated with TURBT (as thoroughly as possible) and definitive radiotherapy (median total dose: 64 Gy, median fractional dose: 2 Gy). Cystectomy was performed when possible for the residual or recurrent invasive cancer following radiotherapy. The median follow-up period was 76 months. RESULTS: The overall survival (OS) and bladder-preserving survival (BPS) rates at 5 years were 38% and 28%, respectively. Univariate analysis indicated that depth of invasion (T2 vs. T3), tumor diameter (< 3 cm vs. > or = 3 cm), and visible (R1) or not visible (R0) residual tumor after TURBT influenced both OS and BPS. In multivariate analysis, absence of visible residual tumor after TURBT was the only significant prognostic factor related to OS (p < 0.001) and BPS (p = 0.002). Five-year OS and BPS were 54% and 43% in T2-3R0 and 14% and 7% in T2-3R1, respectively. CONCLUSIONS: Absence of visible residual tumor after TURBT was significantly associated with better overall survival and bladder-preserving survival for muscle-invasive bladder cancer patients treated with definitive radiotherapy following TURBT.     

老年人晚期非小细胞肺癌三维立体适形放射治疗

目的 探讨老年人非小细胞肺癌(NSCLC)三维立体适形放射治疗(3D-CRT)的临床特点和疗效.方法 对108例由于内科禁忌证或其他情况不能手术的老年人晚期NSCLC施行3D-CRT,单次剂量5～8Gy,隔日1次,总剂量68～82Gy.结果 108例全部完成放射治疗计划,1、2、3年的平均生存率分别为65%、33%、28%.结论 对于有内科禁忌证或由于其他情况不能手术的老年人晚期NSCLC施行3D-CRT是一种比较有效的治疗手段,有助于提高生存率,改善生存质量,减少并发症的发生.     

立体定向放射治疗胰腺癌

目的 对立体定向放射治疗胰腺癌的临床意义进行评价。方法 对16例胰腺癌患者行立体定向放射治疗,病变体积26.5~116.5cm3,肿瘤边缘单次剂量为3~5Gy,治疗10~20次,每日1次,每周治疗5次,治疗后临床和影像手段随访。结果 治疗有效率(完全缓解+部分缓解)为81.2%,合并疼痛患者均有不同程度缓解,6/7患者黄疸消除,生存质量明显改善,中位生存期11个月,死亡原因多为远处转移;治疗副作用根据RTOG标准评价,68.7%患者有轻度早期反应,1例重度晚期反应。结论 立体定向放射治疗胰腺癌是有效的局部控制手段,可明显的缓解症状,改善患者生存质量,并且治疗的并发症可以被临床接受,但肿瘤的远处转移是影响患者生存的主要问题。     

The comparison of transforming growth factor beta-1 serum levels in early-stage breast cancer patients treated with external beam whole breast irradiation plus boost versus interstitial brachytherapy accelerated partial breast irradiation

PURPOSETransforming growth factor beta-1 (TGF-β1) is a profibrotic cytokine used as an early biomarker to develop radiation-induced fibrosis (RIF). This study aimed to compare TGF-β1 serum levels in early-stage breast cancer patients treated with whole-breast radiation therapy (WBRT) plus boost versus accelerated partial breast irradiation (APBI) using multicatheter interstitial brachytherapy.METHODS AND MATERIALSThis clinical trial study was conducted on 20 women with early-stage breast cancer after breast-conserving surgery candidate for adjuvant radiotherapy in Golestan hospital, Ahvaz, in 2021. In one group APBI with high-dose-rate brachytherapy (n = 10), the other group WBRT with external beam radiation plus boost (n = 10) was performed. Serum level of TGF-β1 was evaluated before radiotherapy, immediately after the end of radiotherapy and three months after the end of radiotherapy by Enzyme-linked immunosorbent assay technique (ELISA).ResultsMedian serum TGF-β1 level before radiotherapy was not significantly different between the two groups (p = 0.971). In both APBI and WBRT groups, serum TGF-β1 levels significantly decreased immediately after radiotherapy compared to before treatment (p = 0.005 and p = 0.007, respectively); But three months after radiotherapy, serum TGF-β1 levels increased significantly in the WBRT group (40.50 to 77.41 pg/mL; p = 0.017), while no significant change was observed in the APBI group (24.75 to 30.50 pg/mL; p = 0.332).ConclusionSHigher TGF-β1 values in the WBRT group after radiotherapy can be used as an early and vital biomarker in this treatment, and this data may corroborate links between TGF-beta1 and fibrosis and fibrosis rates between APBI and WBRT; It also shows the preference for using the brachytherapy technique in this group of patients. However, due to the small number of samples, definitive conclusions require further prospective studies.