title: Clinical outcome with adjuvant treatment of endometrial carcinoma using intensity-modulated radiation therapy.
abstract: OBJECTIVE
  To assess local control and chronic toxicity with IMRT for adjuvant treatment of endometrial carcinoma.
  
  
  METHODS
  Forty-seven patients with endometrial cancer were treated with adjuvant IMRT and HDR brachytherapy (HDRB). The external beam dose was between 45 and 50.4 Gy, and all patients received 10 Gy in 2 fractions of HDRB to the vaginal cuff. Eight of these patients were treated with extended field to include the paraaortic region.
  
  
  RESULTS
  IMRT dosimetry showed excellent coverage of the planning target volume (PTV) with mean PTV 95, PTV 110 and PTV 120 of 97.8%, 8.2% and 0.9% respectively. At a median follow-up of 20 months, four patients have recurred at extra pelvic sites. No patient had pelvic recurrence. The treatment was well tolerated with late toxicities as follows: small bowel grade 1: 25%, rectal grade 1: 2% and bladder grade 1: 13%. One patient had grade 3 small bowel toxicity. The 3-year actuarial rate of grade 2 or greater toxicity, disease-free survival and overall survival rate were 3.3%, 84% and 90%, respectively.
  
  
  CONCLUSIONS
  The preliminary analysis of IMRT for adjuvant treatment of endometrial carcinoma shows excellent local control and low toxicity. However, longer follow-up and more patients are needed to ascertain whether the benefits of IMRT treatment seen here translate into long-term reductions in toxicities and local recurrence.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. beriwals@upmc.edu
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: Sheena K
authors.initials: SK
authors.lastname: Jain
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Hayeon
authors.initials: H
authors.lastname: Kim
authors.forename: Kristina
authors.initials: K
authors.lastname: Gerszten
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D016896:Treatment Outcome