Brachytherapy versus external beam radiation in gynecologic rhabdomyosarcoma: A comparative analysis of patient characteristics and survival outcomes.

Authors

Luke Limfueco, Amanda L Schwer, Arya Amini, Scott M Glaser, Hyun Kim, Sagus Sampath, Venita Williams, Brad Nakamura, Josephine Kim, Laurie G Brunette, Joshua G Cohen, Colton J Ladbury

Published in

Brachytherapy. Sep 22, 2026. Epub Sep 22, 2026.

Abstract

Brachytherapy (BT) represents a potential alternative or adjunct to external beam radiation therapy (EBRT), offering localized dosing that minimizes toxicity while preserving organ structure and function. Herein, we compare the patient characteristics and survival outcomes of patients with gynecologic rhabdomyosarcoma (GYN-RMS) treated with BT-containing regimens relative to patients treated with EBRT alone.
This retrospective cohort study utilized National Cancer Database (NCDB) data (2004-2022) to compare patients with GYN-RMS treated with EBRT or BT-containing regimens. Patient characteristics were summarized using descriptive statistics, multivariate logistic regression identified predictors of BT utilization, and overall survival (OS) was estimated using the Kaplan-Meier method and a multivariate Cox proportional hazards model.
A total of 290 patients with a confirmed diagnosis of GYN-RMS treated with radiation therapy were identified. The median year of diagnosis was 2015 (IQR 2010-2018), with a median follow-up of 46 months (IQR 19-86), and a median age of 16 years old (IQR 4-48). Of these patients, 74 received BT-containing regimens and 216 received EBRT alone. Age (odds ratio [OR] 1.02, p < 0.01), vaginal tumors (OR 8.10, p < 0.001), surgery (OR 2.68, p = 0.03), hospital case count (OR 1.01, p < 0.01), and year of diagnosis (OR 1.10, p < 0.01) were positive predictors of choosing BT containing regimens. Alternatively, alveolar histology was a strong independent predictor of choosing EBRT over BT (OR 5.69, p < 0.027). BT was associated with higher overall survival (OS) compared to EBRT at 1 year (97% vs. 94%, p < 0.01), 3 years (84% vs. 68%, p < 0.01), and 5 years (80% vs. 56%, p < 0.01). After adjusting for covariates associated with overall survival, BT-containing regimens were associated with improved OS compared to EBRT alone (hazard ratio 0.47, 95% confidence interval: 0.26-0.85, p = 0.013).
Brachytherapy is an effective therapeutic modality for GYN-RMS, particularly favored in younger patients with lower-stage disease that exhibits more favorable histology amenable to surgical resection. Brachytherapy exhibits similar survival compared with external beam radiation in this group of patients, where superior dose localization and organ preservation are primary concerns.

PMID:
42897012
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

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