title: Volumetric-modulated arc therapy with vaginal cuff simultaneous integrated boost as an alternative to brachytherapy in adjuvant irradiation for endometrial cancer: a prospective study.
abstract: OBJECTIVE
  To report preliminary results of a prospective study using pelvic volumetric-modulated arc therapy and simultaneous integrated boost (SIB-VMAT) on vaginal cuff postoperatively in patients with endometrial cancer (EC).
  
  
  METHODS
  Fifty consecutive patients, submitted surgery for EC, were recruited to SIB-VMAT prescribing a dose of 54 Gy to the pelvis and 66 Gy to the vaginal cuff in 30 fractions. A 2 mm transvaginal probe and magnetic resonance imaging were used to define the vaginal cuff. Toxicity data were collected according to Common Terminology Criteria for Adverse Events v4.0; clinical outcomes were analyzed.
  
  
  RESULTS
  The median follow-up was 26 (range=12 to 39) months. According to International Federation of Gynecology and Obstetrics 2009, the stages were: IB1 in 20%, IB2 in 28%, IIA2 in 16%, IIB in 6%, IIIA in 2%, and IIIC in 28%. The 2-year Overall Survival and Local Control were 96% and 100%, respectively. Two pelvic node failures were registered. Acute gastrointestinal toxicity was: G0 in 12%, G1 in 52%, G2 in 36%; no case of toxicity G3 or more was observed. Acute genitourinary toxicity was: G0 in 10%, G1 in 42%, G2 in 48%; no case of toxicity G3 or more was observed. No late severe gastrointestinal or genitourinary toxicities were reported. A statistical correlation was found between acute G2 gastrointestinal toxicity with bowel V20 Gy ≥ 30%, V20 ≥ 40%, V30 ≥ 30%, Dmax ≥ 45 Gy. Acute G2 genitourinary toxicity was threefold higher with chemotherapy.
  
  
  CONCLUSIONS
  In patients with EC, SIB-VMAT is feasible, and well tolerated. Preliminary data of clinical outcome are promising. Further prospective studies are advocated.
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy dott.filippoalongi@gmail.com.
authors: Filippo
authors: F
authors: Alongi
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy Radiation Oncology School, University of Palermo, Palermo, Italy.
authors: Rosario
authors: R
authors: Mazzola
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Francesco
authors: F
authors: Ricchetti
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Sergio
authors: S
authors: Fersino
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Niccolò Giaj
authors: NG
authors: Levra
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Alba
authors: A
authors: Fiorentino
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Stefania
authors: S
authors: Naccarato
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Gianluisa
authors: G
authors: Sicignano
authors: Statistic Sciences Faculty, University of Palermo, Palermo, Italy.
authors: Gioacchino
authors: G
authors: Di Paola
authors: Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Ruggero
authors: R
authors: Ruggieri
authors: Medical Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Stefania
authors: S
authors: Gori
authors: Gynecological Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
authors: Marcello
authors: M
authors: Ceccaroni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D019583:Dose Fractionation, Radiation; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology / Q000528:radiation effects; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated
keywords: Endometrial cancer; SIB; VMAT; gynecological cancer