Whole abdominal irradiation in endometrial cancer - a single institution study.
OBJECTIVE
To examine the use of whole abdominal irradiation (WAI) open field technique in patients with stage III endometrial cancer (EC).


METHODS
Between 1993 and 2007, 26 patients (age 39-70 years, median 58) with stage III EC (IIIA 15, IIIB 2, IIIC 8) were treated with WAI after primary surgery. Five (21)) patients had grade 1 disease, 18 (67%) grade 2 and 3 (12%) grade 3. In 2 (8%) patients a second laparotomy was carried out before the radiotherapy (RT) referral. Ascites and positive peritoneal cytology was present in 3 (15%) and 4 (20%) patients, respectively. After surgery, residua < 2 cm in the upper abdomen were left in 2 patients. WAI was delivered using Co 60 anterior-posterior photon fields to encompass the peritoneal cavity. In 84% of the patients WAI consisted of 30 Gy, delivered mainly in daily fractions of 1.5 Gy (81%), 5 fractions per week. For the remaining patients the dose was 25 Gy (8%) and 20 Gy (8%), respectively. After abdominal RT, 85% of the patients were given a pelvic boost to reach 45 - 50 Gy with 1.8 Gy/fraction/day, using a Co 60 unit. In 5 (19%) patients boost to 45-50 Gy with 1.8 Gy/fraction/day to other risk sites was also given. Two (8%) of 26 patients received 2 cycles of platinum-based chemotherapy. The mean follow-up time was 13.41 years.


RESULTS
The treatment time ranged from 14-74 days, median 48. The overall survival (OS) rate was 93% at 5, 10 and 14 years. Ten (38.5%) patients received their treatment with no interruption, and in 16 (61.5%) patients RT was transiently interrupted because of acute gastrointestinal and hematological toxicity. Neither grade 4 acute complications nor mortality while receiving treatment were observed. Late side effects (grade 2 gastrointestinal complications) developed in 1 (5%) patient. During the observation period a second primary malignancy was recorded in 1 patient.


CONCLUSIONS
WAI achieves a quite favorable 5- and 14-year survival rate with an acceptable risk of acute and late side effects in properly selected patients with stage III EC. WAI as a sole or a part of combined treatment warrants further investigation in patients with high-risk EC.
Department of Radiotherapy, University Hospital Queen Giovanna-ISUL, Sofia, Bulgaria. lgocheva2001@yahoo.co.uk
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Gocheva
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Slavchev
D000005:Abdomen / Q000528:radiation effects*; D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome