Management of Bartholin's gland carcinoma using high-dose-rate interstitial brachytherapy boost.

PURPOSE: To describe the patterns of use, clinical outcomes, and dose-volume histogram parameters of high-dose-rate interstitial brachytherapy (HDR-ISBT) in the management of Bartholin's gland cancer.

METHODS AND MATERIALS: Five patients with Stage II-III Bartholin's gland carcinoma treated with CT-based HDR-ISBT boost were reviewed. Plans were generated using an inverse planning simulated annealing algorithm. Dose-volume histogram parameters were assessed. The total doses of HDR-ISBT and EBRT were converted to total equivalent dose in 2Gy (EQD2).

RESULTS: All 5 patients received HDR-ISBT as a boost (median dose, 30Gy) after EBRT (median dose, 45Gy). Three patients received postoperative irradiation for gross residual tumor or positive surgical margins and 2 patients were treated by primary chemoradiotherapy. The median V100, D90, and D100 for the CTV were 98.3%, 89Gy10, and 64Gy10 (EQD2), respectively. A complete response was observed in all patients. No local recurrence occurred. All patients remain alive and free of disease (median followup, 78 months; range, 8-93). Severe vaginal toxicities were observed, including vaginal necrosis that resolved with hyperbaric oxygen therapy.

CONCLUSIONS: HDR-ISBT boost after EBRT offers excellent long-term local control in patients with Bartholin's gland carcinoma. HDR-ISBT should be considered for positive surgical margins or residual tumor after surgery and for locally advanced malignancies treated by primary chemoradiotherapy.