title: Postoperative intensity-modulated arc therapy for cervical and endometrial cancer: a prospective report on toxicity.
abstract: OBJECTIVE
  To report on toxicity after postoperative intensity-modulated arc therapy (IMAT) for cervical (CC) and endometrial cancer (EC).
  
  
  METHODS
  Twenty-four CC and 41 EC patients were treated with postoperative IMAT. If indicated, para-aortic lymph node irradiation (preventive or when affected, PALN) and/or concomitant cisplatin (40 mg/m(2), weekly) was administered. The prescribed dose for IMAT was 45 Gy (CC, 25 fractions) and 46 Gy (EC, 23 fractions), followed by a brachytherapeutic boost if possible. Radiation-related toxicity was assessed prospectively. The effect of concomitant cisplatin and PALN irradiation was evaluated.
  
  
  RESULTS
  Regarding acute toxicity (n = 65), Grade 3 and 2 acute gastrointestinal toxicity was observed in zero and 63% of patients (79% CC, 54% EC), respectively. Grade 3 and 2 acute genitourinary toxicity was observed in 1% and 18% of patients, respectively. Grade 2 (21%) and 3 (12%) hematologic toxicity (n = 41) occurred only in CC patients. Seventeen percent of CC patients and 2% of EC patients experienced Grade 2 fatigue and skin toxicity, respectively. Adding cisplatin led to an increase in Grade >2 nausea (57% vs. 9%; p = 0.01), Grade 2 nocturia (24% vs. 4%; p = 0.03), Grade ≥ 2 hematologic toxicity (38% vs. nil, p = 0.003), Grade ≥ 2 leukopenia (33% vs. nil, p = 0.009), and a strong trend toward more fatigue (14% vs. 2%; p = 0.05). Para-aortic lymph node irradiation led to an increase of Grade 2 nocturia (31% vs. 4%, p = 0.008) and a strong trend toward more Grade >2 nausea (44% vs. 18%; p = 0.052). Regarding late toxicity (n = 45), no Grade 3 or 4 late toxicity occurred. Grade 2 gastrointestinal toxicity, genitourinary toxicity, and fatigue occurred in 4%, 9%, and 1% of patients. Neither concomitant cisplatin nor PALN irradiation increased late toxicity rates.
  
  
  CONCLUSIONS
  Postoperative IMAT for EC or CC is associated with low acute and late toxicity. Concomitant chemotherapy and PALN irradiation influences acute but not late toxicity.
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. Katrien.Vandecasteele@uzgent.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Vandecasteele
authors.forename: Philippe
authors.initials: P
authors.lastname: Tummers
authors.forename: Amin
authors.initials: A
authors.lastname: Makar
authors.forename: Marc
authors.initials: M
authors.lastname: van Eijkeren
authors.forename: Louke
authors.initials: L
authors.lastname: Delrue
authors.forename: Hannelore
authors.initials: H
authors.lastname: Denys
authors.forename: Bieke
authors.initials: B
authors.lastname: Lambert
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Beerens
authors.forename: Rudy
authors.initials: R
authors.lastname: Van den Broecke
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lambein
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000628:therapy; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007422:Intestines / Q000528:radiation effects; D007970:Leukopenia / Q000209:etiology; D015182:Lymphatic Irradiation / Q000379:methods; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D053158:Nocturia / Q000209:etiology; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects; D011184:Postoperative Period; D011446:Prospective Studies; D011838:Radiation-Sensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012867:Skin / Q000528:radiation effects; D013270:Stomach / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D002945:Cisplatin