Postoperative pelvic intensity-modulated radiotherapy in high risk endometrial cancer Journal Article

Authors: Shih, K. K.; Milgrom, S. A.; Abu-Rustum, N. R.; Kollmeier, M. A.; Gardner, G. J.; Tew, W. P.; Barakat, R. R.; Alektiar, K. M.
Article Title: Postoperative pelvic intensity-modulated radiotherapy in high risk endometrial cancer
Abstract: Objective According to national surveys, the use of intensity-modulated radiation therapy (IMRT) in gynecologic cancers is on the rise, yet there is still some reluctance to adopt adjuvant IMRT as standard practice. The purpose of this study is to report a single-institution experience using postoperative pelvic IMRT with or without chemotherapy in high-risk endometrial cancer. Methods From 11/2004 to 12/2009, 46 patients underwent hysterectomy/bilateral salpingo-oophorectomy for stage I-III (22% stage I/II and 78% stage III) endometrial cancer. Median IMRT dose was 50.4 Gy. Adjuvant chemotherapy was given to 30 (65%) patients. Results With a median follow-up of 52 months, 4 patients recurred: 1 vaginal plus lung metastasis, 2 isolated para-aortic recurrences, and 1 lungs and liver metastasis. Five-year relapse rate was 9% (95% CI, 0-13.6%). Five-year disease-free survival (DFS) was 88% (95% CI, 77-98%) and overall survival (OS) was 97% (95% CI, 90-100%). There were 2 patients with non-hematological grade 3 toxicity: 1 (2%) acute and 1 (2%) chronic gastrointestinal toxicity. In patients treated with IMRT and chemotherapy (n = 30), 5 had grade 3 leukopenia, 8 grade 2 anemia, and 2 grade 2 thrombocytopenia. Conclusions Oncologic outcomes with postoperative IMRT were very good, with DFS and OS rates of > 88% at median follow-up of 52 months, despite a preponderance (78%) of stage III disease. Toxicity was minimal even in the setting of an aggressive trimodality (65% of patients) approach. Data from this study and emerging data from RTOG trial 0418 demonstrate the advantages of IMRT in high-risk endometrial cancer. © 2012 Elsevier Inc.
Keywords: chemotherapy; endometrial cancer; imrt; postoperative; high risk
Journal Title: Gynecologic Oncology
Volume: 128
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2013-03-01
Start Page: 535
End Page: 539
Language: English
DOI: 10.1016/j.ygyno.2012.11.020
PROVIDER: scopus
PUBMED: 23174538
Notes: --- - "Export Date: 1 March 2013" - "CODEN: GYNOA" - "Source: Scopus"
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MSK Authors
  1. Ginger J Gardner
    145 Gardner
  2. Richard R Barakat
    627 Barakat
  3. Kaled M Alektiar
    262 Alektiar
  4. Marisa A Kollmeier
    158 Kollmeier
  5. Sarah Allison Milgrom
    22 Milgrom
  6. Karin Kuan-Hui Shih
    41 Shih
  7. William P Tew
    142 Tew