title: Whole-abdominal radiation in endometrial carcinoma: an analysis of toxicity, patterns of recurrence, and survival.
abstract: OBJECTIVE
  The purpose of this study was to determine the toxicity, patterns of recurrence, and survival in high-risk endometrial cancer patients treated with whole-abdominal radiation.
  
  
  METHODS
  All patients with endometrial cancer treated at Northwestern University since 1994 and at Rush University since 1993 were retrospectively reviewed. Patients believed to be at high risk for intra-abdominal recurrence and who received whole-abdominal radiation were reviewed for this study.
  
  
  RESULTS
  A total of 30 patients completed whole-abdominal radiation (WAR) and were available for study. The mean and median follow-up was 2.3 and 2.1 years, respectively, with a range of 0.13 to 6.1 years. Seventy-eight percent of the cohort received surgical staging with bilateral salpingo-oophorectomy/total abdominal hysterectomy/lymph node sampling. Forty-seven percent of the patients were found to have serous histology as a component of their tumor. Surgical staging results included 19% stage 1B, 4% stage IC, 8% stage IIB, 37% stage IIIA, 26% stage IIIC, and 7% stage IVB. Two patients had gross residual disease at the completion of surgery. Megestrol acetate (Megace) was used as an adjuvant treatment in 37% of patients, and no cases received initial chemotherapy. All patients received WAR with a mean total dose and dose per fraction of 2620 and 143 cGy, respectively. Twenty-two percent of patients received a para-aortic boost. The mean total pelvic dose was 4956 cGy. Seventy percent of patients received a vaginal cuff boost. Eight percent of patients had grade 3 acute gastrointestinal morbidity, and 4% had grade 4 acute gastrointestinal morbidity. No other grade 3 or greater acute or long-term morbidity was noted. At last follow-up, seven (23%) patients had experienced recurrence. The pattern of first recurrence was 0% in the vaginal cuff, 3% other vaginal, 7% pelvic, 7% upper abdominal, 3% lung, 7% bone, and 7% para-aortic lymph nodes. Ultimate recurrences were similar. At last follow-up, 77% patients had no evidence of disease, 13% were alive with disease, and 10% had died of disease.
  
  
  CONCLUSIONS
  Utilizing a conservatrive total whole-abdominal radiation dose and limited para-aortic nodal boost resulted in very tolerable treatments. The patterns of recurrence and survival in this early report are encouraging.
authors.affiliation: Section of Radiation Oncology, Robert H Lurie Cancer Center Northwestern University, Chicago, Illinois, USA.
authors.forename: W
authors.initials: W
authors.lastname: Small
authors.forename: A
authors.initials: A
authors.lastname: Mahadevan
authors.forename: P
authors.initials: P
authors.lastname: Roland
authors.forename: L
authors.initials: L
authors.lastname: Vallow
authors.forename: T
authors.initials: T
authors.lastname: Zusag
authors.forename: D
authors.initials: D
authors.lastname: Fishman
authors.forename: S
authors.initials: S
authors.lastname: Massad
authors.forename: A
authors.initials: A
authors.lastname: Rademaker
authors.forename: J A
authors.initials: JA
authors.lastname: Kalapurakal
authors.forename: S
authors.initials: S
authors.lastname: Chang
authors.forename: J
authors.initials: J
authors.lastname: Lurain
mesh_terms: D000008:Abdominal Neoplasms / Q000517:prevention & control* / Q000556:secondary*; D000231:Adenocarcinoma, Papillary; D001918:Brachytherapy; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000532:radiotherapy*; D010052:Ovariectomy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis