Abstract
BackgroundTo evaluate feasibility and preliminary outcomes associated with sequential whole abdomen irradiation (WAI) as consolidative treatment following comprehensive surgery and systemic chemotherapy for advanced endometrial cancer.MethodsWe conducted a retrospective analysis of patients treated at our institution from 2000 to 2011. Inclusion criteria were stage III-IV endometrial cancer patients with histological proof of one or more sites of extra-uterine abdomen-confined disease, treated with WAI as part of multimodal therapy. Endpoints were feasibility, acute toxicity, late effects, recurrence-free survival (RFS) and overall survival (OS). Twenty patients were identified. Chemotherapy consisted of 3 to 6 cycles of a platinum-paclitaxel regimen in 18 patients. WAI was delivered using conventional technique to a median total dose of 27.5 Gy.ResultsNo grade 4 toxicities occurred during chemotherapy or radiotherapy. No radiation dose reduction was necessary. Three patients developed small bowel obstruction, all in the context of recurrent intraperitoneal disease. Kaplan-Meier estimates and 95% confidence intervals for RFS and OS at one year were 63% (38–80%) and 83% (56-94%) and at 3 years 57% (33-76%) and 62% (34-81%), respectively. On univariate Cox analysis, stage IVB and serous papillary (SP) histology were found to be statistically significantly (at the p = 0.05 level) associated with worse RFS and OS. The peritoneal cavity was the most frequent site of initial failure.ConclusionsConsolidative WAI following chemotherapy is feasible and can be performed without interruption with manageable acute and late toxicity. Patients with endometrioid adenocarcinoma, especially stage FIGO III, had favorable outcomes possibly meriting prospective evaluation of the addition of WAI following chemotherapy in selected patients. Patients with SP do poorly and do not routinely benefit from this approach.
Highlights
To evaluate feasibility and preliminary outcomes associated with sequential whole abdomen irradiation (WAI) as consolidative treatment following comprehensive surgery and systemic chemotherapy for advanced endometrial cancer
Feasibility and acute toxicity No Common terminology criteria for adverse events (CTCAE) grade 4 side effects were observed during chemotherapy or radiotherapy
Acute toxicity was manageable with most patients experiencing CTCAE grade 1–2 fatigue, neuropathy and/or nausea during chemotherapy and CTCAE grade 1–2 nausea and/or diarrhea that responded to symptomatic medication during radiotherapy
Summary
To evaluate feasibility and preliminary outcomes associated with sequential whole abdomen irradiation (WAI) as consolidative treatment following comprehensive surgery and systemic chemotherapy for advanced endometrial cancer. Endometrial cancer (EC) is the most common malignancy of the female genital tract in the United States with an estimated 47,100 new cases and 8,000 deaths in 2012 [1]. Most patients are diagnosed with early stage disease and have an excellent prognosis. For Gynecologic Oncology Group (GOG) protocol 122 prospectively randomized patients between chemotherapy and whole abdomen irradiation (WAI), and established the superiority of systemic chemotherapy [5]. WAI is generally no longer recommended in the postoperative treatment of patients with stage III or IV disease. Recurrences were frequent in both treatment arms of GOG 122. More than half of the patients progressed or failed in the abdomen illustrating the need for further therapeutic improvements in this high-risk patient population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
