title: Clinical outcomes of image guided radiation therapy (IGRT) with gold fiducial vaginal cuff markers for high-risk endometrial cancer.
abstract: OBJECTIVE
  To report two year clinical outcomes of image guided radiation therapy (IGRT) to the vaginal cuff and pelvic lymph nodes in a series of high-risk endometrial cancer patients.
  
  
  METHODS
  Twenty-six consecutive high-risk endometrial cancer patients requiring adjuvant radiation to the vaginal cuff and regional lymph nodes were treated with vaginal cuff fiducial-based IGRT. Seventeen (65%) received sequential chemotherapy, most commonly with a sandwich technique. Brachytherapy followed external radiation in 11 patients to a median dose of 18 Gy in 3 fractions. The median external beam dose delivered was 47.5 Gy in 25 fractions.
  
  
  RESULTS
  All 656 fractions were successfully imaged and treated. The median overall translational shift required for correction was 9.1 mm (standard deviation, 5.2 mm) relative to clinical set-up with skin tattoos. Shifts of 1 cm, 1.5 cm, and 2 cm or greater were performed in 43%, 14%, and 4% of patients, respectively. Acute grade 2 gastrointestinal (GI) toxicity occurred in eight patients (30%) and grade 3 toxicity occurred in one. At two years, there have been no local or regional failures and actuarial overall survival is 95%.
  
  
  CONCLUSIONS
  Daily image guidance for high-risk endometrial cancer results in a low incidence of acute GI/genitourinary (GU) toxicity with uncompromised tumor control at two years. Vaginal cuff translations can be substantial and may possibly result in underdosing if not properly considered.
authors.affiliation: Department of Radiation Oncology, Penrose Cancer Center, Colorado Springs, CO 80907, USA. dralmonroe@yahoo.com
authors.forename: Alan T
authors.initials: AT
authors.lastname: Monroe
authors.forename: Dirk
authors.initials: D
authors.lastname: Pikaart
authors.forename: Anuj V
authors.initials: AV
authors.lastname: Peddada
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D019583:Dose Fractionation, Radiation; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D057918:Fiducial Markers; D006046:Gold; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000000981:diagnostic imaging*
chemical_list: D000970:Antineoplastic Agents; D006046:Gold