title: A phase II study of intensity modulated radiation therapy to the pelvis for postoperative patients with endometrial carcinoma: radiation therapy oncology group trial 0418.
abstract: OBJECTIVE
  To determine the feasibility of pelvic intensity modulated radiation therapy (IMRT) for patients with endometrial cancer in a multi-institutional setting and to determine whether this treatment is associated with fewer short-term bowel adverse events than standard radiation therapy.
  
  
  METHODS
  Patients with adenocarcinoma of the endometrium treated with pelvic radiation therapy alone were eligible. Guidelines for target definition and delineation, dose prescription, and dose-volume constraints for the targets and critical normal structures were detailed in the study protocol and a web-based atlas.
  
  
  RESULTS
  Fifty-eight patients were accrued by 25 institutions; 43 were eligible for analysis. Forty-two patients (98%) had an acceptable IMRT plan; 1 had an unacceptable variation from the prescribed dose to the nodal planning target volume. The proportions of cases in which doses to critical normal structures exceeded protocol criteria were as follows: bladder, 67%; rectum, 76%; bowel, 17%; and femoral heads, 33%. Twelve patients (28%) developed grade ≥2 short-term bowel adverse events.
  
  
  CONCLUSIONS
  Pelvic IMRT for endometrial cancer is feasible across multiple institutions with use of a detailed protocol and centralized quality assurance (QA). For future trials, contouring of vaginal and nodal tissue will need continued monitoring with good QA and better definitions will be needed for organs at risk.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. ajhingra@mdanderson.org
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Kathryn
authors.initials: K
authors.lastname: Winter
authors.forename: Lorraine
authors.initials: L
authors.lastname: Portelance
authors.forename: Brigitte
authors.initials: B
authors.lastname: Miller
authors.forename: Mohammad
authors.initials: M
authors.lastname: Salehpour
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gaur
authors.forename: Luis
authors.initials: L
authors.lastname: Souhami
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.forename: Lawrence
authors.initials: L
authors.lastname: Berk
authors.forename: David
authors.initials: D
authors.lastname: Gaffney
mesh_terms: D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005270:Femur Head / Q000528:radiation effects; D006801:Humans; D007422:Intestines / Q000528:radiation effects; D008875:Middle Aged; D058958:Organs at Risk / Q000000981:diagnostic imaging* / Q000528:radiation effects; D011182:Postoperative Care; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012007:Rectum / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects; D014621:Vagina / Q000000981:diagnostic imaging