title: Postoperative pelvic intensity-modulated radiotherapy in high risk endometrial cancer.
abstract: OBJECTIVE
  According to national surveys, the use of intensity-modulated radiation therapy (IMRT) in gynecologic cancers is on the rise, yet there is still some reluctance to adopt adjuvant IMRT as standard practice. The purpose of this study is to report a single-institution experience using postoperative pelvic IMRT with or without chemotherapy in high-risk endometrial cancer.
  
  
  METHODS
  From 11/2004 to 12/2009, 46 patients underwent hysterectomy/bilateral salpingo-oophorectomy for stage I-III (22% stage I/II and 78% stage III) endometrial cancer. Median IMRT dose was 50.4Gy. Adjuvant chemotherapy was given to 30 (65%) patients.
  
  
  RESULTS
  With a median follow-up of 52months, 4 patients recurred: 1 vaginal plus lung metastasis, 2 isolated para-aortic recurrences, and 1 lungs and liver metastasis. Five-year relapse rate was 9% (95% CI, 0-13.6%). Five-year disease-free survival (DFS) was 88% (95% CI, 77-98%) and overall survival (OS) was 97% (95% CI, 90-100%). There were 2 patients with non-hematological grade 3 toxicity: 1 (2%) acute and 1 (2%) chronic gastrointestinal toxicity. In patients treated with IMRT and chemotherapy (n=30), 5 had grade 3 leukopenia, 8 grade 2 anemia, and 2 grade 2 thrombocytopenia.
  
  
  CONCLUSIONS
  Oncologic outcomes with postoperative IMRT were very good, with DFS and OS rates of >88% at median follow-up of 52months, despite a preponderance (78%) of stage III disease. Toxicity was minimal even in the setting of an aggressive trimodality (65% of patients) approach. Data from this study and emerging data from RTOG trial 0418 demonstrate the advantages of IMRT in high-risk endometrial cancer.
authors.affiliation: Departments of Surgery, Memorial-Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Karin K
authors.initials: KK
authors.lastname: Shih
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Milgrom
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Kollmeier
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: William P
authors.initials: WP
authors.lastname: Tew
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Kaled M
authors.initials: KM
authors.lastname: Alektiar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010052:Ovariectomy; D011182:Postoperative Care; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies