title: Administration of concurrent vaginal brachytherapy during chemotherapy for treatment of endometrial cancer.
abstract: OBJECTIVE
  To evaluate the tolerability and toxicity of administering vaginal brachytherapy (VB) concurrently during chemotherapy compared with the sequential approach for patients with endometrial cancer.
  
  
  METHODS
  A retrospective analysis of 372 surgically staged patients with endometrial cancer American Joint Committee on Cancer 2009 stages I to IV treated with adjuvant postoperative radiation therapy (RT) at our institution from 2001 to 2012 was conducted. All patients received VB+external beam RT (EBRT)+6 cycles of adjuvant carboplatin- and paclitaxel-based chemotherapy. The VB mean dose was 15.08 Gy (range, 15-20 Gy), with 3 to 4 weekly applications, and the EBRT mean dose was 45 Gy delivered with 3-dimensional or intensity modulated RT techniques. Hematologic, gastrointestinal (GI), and genitourinary (GU) toxicities were assessed by Common Toxicity Criteria (CTC) and compared between sequential and concurrent chemotherapy and VB schedules.
  
  
  RESULTS
  Among patients who received RT and adjuvant chemotherapy, 180 of 372 patients (48%) received RT sandwiched between cycles 3 and 4 of chemotherapy. A separate group of 192 patients (52%) were treated with VB during the first 3 cycles of chemotherapy, with a weekly application on nonchemotherapy days, and received the EBRT portion in a sandwiched fashion. Patients treated with VB during chemotherapy had a decreased overall treatment time by 4 weeks (P<.001; 95% confidence interval: 3.99-4.02) and sustained no difference in CTC-graded acute hematologic, GI, or GU toxicities in comparison with the patients treated with VB and chemotherapy in a sequential manner (P>.05). CTC grade 3 or 4 hematologic, GI, and GU toxicities were zero.
  
  
  CONCLUSIONS
  VB during chemotherapy is well tolerated, decreases overall treatment time, and does not render more toxicity than the sequential regimen.
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Nagar
authors.forename: Dustin
authors.initials: D
authors.lastname: Boothe
authors.forename: Amar
authors.initials: A
authors.lastname: Parikh
authors.forename: Menachem
authors.initials: M
authors.lastname: Yondorf
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
authors.forename: Divya
authors.initials: D
authors.lastname: Gupta
authors.forename: Kevin
authors.initials: K
authors.lastname: Holcomb
authors.forename: Thomas
authors.initials: T
authors.lastname: Caputo
authors.forename: K S Clifford
authors.initials: KS
authors.lastname: Chao
authors.forename: Dattatreyudu
authors.initials: D
authors.lastname: Nori
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000528:radiation effects; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005835:Genitalia / Q000000981:diagnostic imaging / Q000528:radiation effects; D006801:Humans; D007044:Hysterectomy; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000528:radiation effects; D008875:Middle Aged; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects; D017239:Paclitaxel / Q000008:administration & dosage; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012007:Rectum / Q000000981:diagnostic imaging / Q000528:radiation effects; D012189:Retrospective Studies; D013997:Time Factors; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000528:radiation effects
chemical_list: D016190:Carboplatin; D017239:Paclitaxel