Postoperative accelerated radiotherapy with cytoprotection followed by three-dimensional conformal boost in patients with early endometrial/cervical cancer.
OBJECTIVE
Adjuvant external beam radiotherapy is highly recommended for uterine carcinomas invading beyond the inner half of the myometrium or cervical stage IIa carcinomas. The addition of a booster intracavitary dose is widely used.


METHODS
We assessed the feasibility and toxicity of a hypofractionated accelerated conformal radiotherapy scheme (2.7 Gy per fraction, for 14 consecutive fractions to the pelvis) supported with the cytoprotective agent amifostine (HypoARC). The amifostine dose was individualized (500-1000 mg daily subcutaneously). A booster dose of radiation was given to the vagina and stump using a 6-field 3D-conformal technique (3 x 4 Gy or 4 x 3 Gy) instead of intracavitary radiotherapy.


RESULTS
Grade 2 diarrhea appeared in 9/25 (36%) and grade 1 cystitis in 7/25 (28%) cases. Analysis according to the amifostine dose level clearly showed reduced toxicity in patients receiving a daily dose of 750-1000 mg (P < 0.009). Within a median follow-up of 31 months (range, 11-52), there was only one case with grade 2 colitis (the patient had received no amifostine). None of the patients treated has relapsed locally or to distant organs within a median of 31 months of follow-up.


CONCLUSIONS
It is concluded that HypoARC followed by 3D-conformal booster dose to the vagina is feasible and convenient for patients and for busy radiotherapy departments, as it reduces the overall time by 50%. When supported by high-dose daily amifostine, it has an impressively low rate of early and late radiation toxicity.
Koukourakis
Michael I
MI
Department of Radiotherapy and Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece. targ@her.forthnet.gr
Tsoutsou
Pelagia G
PG
Abatzoglou
Ioannis
I
Soulimioti
Georgia
G
Sismanidou
Kyriaki
K
Liberis
Vassilios
V
Giatromanolaki
Alexandra
A
Sivridis
Efthimios
E
Galazios
George
G
D004999:Amifostine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019610:Cytoprotection; D016889:Endometrial Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D011184:Postoperative Period; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000628:therapy*; D014621:Vagina / Q000473:pathology / Q000528:radiation effects
D011837:Radiation-Protective Agents; D004999:Amifostine