Long-term outcomes using adjuvant pelvic intensity-modulated radiotherapy (IMRT) for endometrial carcinoma

Publication date: Available online 15 June 2016
Source:Practical Radiation Oncology
Author(s): Siping He, Beant S. Gill, Dwight E. Heron, Joseph L. Kelley, Paniti Sukumvanich, Alexander B. Olawaiye, Robert P. Edwards, John Comerci, Sushil Beriwal
PurposeTo evaluate the long-term outcome and toxicity of adjuvant intensity-modulated radiotherapy (IMRT) for high-risk endometrial carcinoma via a retrospective institutional review of patients treated in this setting with extended follow-up.Methods and MaterialsPatients with endometrial cancer who underwent comprehensive surgical staging followed by adjuvant IMRT with or without sequential chemotherapy between 1999 to 2010 were reviewed. Median doses delivered with IMRT and brachytherapy were 45 Gy in 25 fractions and 10 Gy in 2 fractions; 10.2% received extended field and 94.5% received vaginal brachytherapy. Kaplan-Meier estimates are provided for rates of locoregional (in-field) relapse (LRR), distant metastasis (DM), and disease-free (DFS) and overall (OS) survival. GI and GU toxicity reported were graded with the CTCAE 4.03.Results128 patients were identified. Median age at diagnosis was 64 years. Most patients (82.8%) had endometrioid adenocarcinoma followed by papillary serous (10.2%), clear cell (4.7%), and carcinosarcoma (2.3%). FIGO staging distribution was as follows: IA 13.3%, IB 32.8%, II 30.4%, IIIA 5.5%, IIIC1 9.4%, IIIC2 8.6%. Most (85.9%) underwent nodal dissections (28.1% pelvic only and 57.8% pelvic and para-aortic). Two patients (1.6%) experienced acute grade 3 GI toxicity; no other acute grade ≥3 GI/GU toxicities were noted. With a median follow-up of 57.0 months, 5-year LRR was 2.5%: vagina (n=3), parametrium (n=1), pelvic node (n=1). Five-year estimates of DM, DFS, and OS were 16.5%, 73.4%, and 77.4%, respectively. Five-year actuarial rates of late grade 3 GI and GU toxicities were 3.2% and 0.0%. The 5-year rate of symptomatic pelvic insufficiency fracture was 4.4%.ConclusionsThis study represents the largest cohort of endometrial cancer patients with extended follow-up receiving adjuvant IMRT. High rates of pelvic disease control and limited late toxicities demonstrate safety and efficacy of this approach in the setting of extended follow-up.



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