title: Severe late complications in patients with uterine cancer treated with postoperative radiotherapy.
abstract: OBJECTIVE
  Severe late complications, particularly radiation enterocolitis and leg edema, remain major problems in patients with uterine cancer, who have undergone hysterectomy and postoperative external beam radiotherapy (EBRT). We carried out this retrospective analysis to identify the incidence of risk factors for such complications.
  
  
  METHODS
  The records of 228 patients, who underwent radical hysterectomy and postoperative EBRT (uterine cervix: 149 patients; uterine corpus: 79 patients) were reviewed retrospectively. The majority of the patients (90.8%) were treated with 50 to 50.4 Gy EBRT in conventional fractionations with anteroposterior fields. Intracavitary brachytherapy (ICBT) was administered to 9 patients (3.9%), and 35 patients (15.2%) received chemotherapy. The median follow-up for all 228 patients was 81.7 months (range, 1-273 months).
  
  
  RESULTS
  Nineteen patients (8.3%) developed severe radiation enterocolitis with a median latency of 12.6 months, and the ileum was the most frequently affected site. On multivariate analysis, smoking was an independent predictor of severe radiation enterocolitis. Nineteen patients (8.3%) developed severe leg edema with a median latency of 32.7 months. The degree of leg edema did not improve in any of the 19 patients despite intensive treatment. On multivariate analysis, addition of ICBT was an independent predictor of severe leg edema.
  
  
  CONCLUSIONS
  Severe radiation enterocolitis and severe leg edema were each observed in approximately 8% of patients with uterine cancer, who underwent postoperative radiotherapy. Severe radiation enterocolitis correlated strongly with smoking, and severe leg edema correlated strongly with addition of ICBT. These factors should be considered before administering postoperative radiotherapy to uterine cancer patients.
authors.affiliation: Department of Radiology, University of the Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Kasuya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Iraha
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nagai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shiraishi
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirakawa
authors.forename: Hironori
authors.initials: H
authors.lastname: Samura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Kakinohana
authors.forename: Wataru
authors.initials: W
authors.lastname: Kudaka
authors.forename: Morihiko
authors.initials: M
authors.lastname: Inamine
authors.forename: Takuro
authors.initials: T
authors.lastname: Ariga
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nishimaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Aoki
authors.forename: Sadayuki
authors.initials: S
authors.lastname: Murayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004487:Edema / Q000209:etiology*; D004760:Enterocolitis / Q000209:etiology*; D005260:Female; D006801:Humans; D007866:Leg / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000150:complications* / Q000532:radiotherapy / Q000601:surgery*; D055815:Young Adult