title: Methods, safety, and early clinical outcomes of dose escalation using simultaneous integrated and sequential boosts in patients with locally advanced gynecologic malignancies.
abstract: OBJECTIVE
  To evaluate the safety of dose escalated radiotherapy using a simultaneous integrated boost technique in patients with locally advanced gynecological malignancies.
  
  
  METHODS
  Thirty-nine women with locally advanced gynecological malignancies were treated with intensity modulated radiation therapy utilizing a simultaneous integrated boost (SIB) technique for gross disease in the para-aortic and/or pelvic nodal basins, sidewall extension, or residual primary disease. Women were treated to 45Gy in 1.8Gy fractions to elective nodal regions. Gross disease was simultaneously treated to 55Gy in 2.2Gy fractions (n=44 sites). An additional sequential boost of 10Gy in 2Gy fractions was delivered if deemed appropriate (n=29 sites). Acute and late toxicity, local control in the treated volumes (LC), overall survival (OS), and distant metastases (DM) were assessed.
  
  
  RESULTS
  All were treated with a SIB to a dose of 55Gy. Twenty-four patients were subsequently treated with a sequential boost to a median dose of 65Gy. Median follow-up was 18months. Rates of acute>grade 2 gastrointestinal (GI), genitourinary (GU), and hematologic (heme) toxicities were 2.5%, 0%, and 30%, respectively. There were no grade 4 acute toxicities. At one year, grade 1-2 late GI toxicities were 24.5%. There were no grade 3 or 4 late GI toxicities. Rates of grade 1-2 late GU toxicities were 12.7%. There were no grade 3 or 4 late GU toxicities.
  
  
  CONCLUSIONS
  Dose escalated radiotherapy using a SIB results in acceptable rates of acute toxicity.
authors.affiliation: Duke University Department of Radiation Oncology, Durham, NC, USA. Electronic address: john.m.boyle@duke.edu.
authors.forename: John
authors.initials: J
authors.lastname: Boyle
authors.affiliation: Duke University Department of Radiation Oncology, Durham, NC, USA.
authors.forename: Oana
authors.initials: O
authors.lastname: Craciunescu
authors.affiliation: Duke University Department of Radiation Oncology, Durham, NC, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Steffey
authors.affiliation: Duke University Department of Radiation Oncology, Durham, NC, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Cai
authors.affiliation: Duke University Department of Radiation Oncology, Durham, NC, USA.
authors.forename: Junzo
authors.initials: J
authors.lastname: Chino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*
keywords: Gynecologic malignancies; Normal tissue constraints; Safety; Simultaneous integrated boost; Toxicity; Treatment planning