title: Radiation-Associated Toxicities in Obese Women with Endometrial Cancer: More Than Just BMI?
abstract: OBJECTIVE
  The study characterizes the impact of obesity on postoperative radiation-associated toxicities in women with endometrial cancer (EC).
  
  
  METHODS
  A retrospective study identified 96 women with EC referred to a large urban institution's radiation oncology practice for postoperative whole pelvic radiotherapy (WPRT) and/or intracavitary vaginal brachytherapy (ICBT). Demographic and clinicopathologic data were obtained. Toxicities were graded according to RTOG Acute Radiation Morbidity Scoring Criteria. Follow-up period ranged from 1 month to 11 years (median 2 years). Data were analyzed by χ(2), logistic regression, and recursive partitioning analyses.
  
  
  RESULTS
  68 EC patients who received WPRT and/or ICBT were analyzed. Median age was 52 years (29-73). The majority were Hispanic (71%). Median BMI at diagnosis was 34.5 kg/m(2) (20.5-56.6 kg/m(2)). BMI was independently associated with radiation-related cutaneous (p = 0.022) and gynecologic-related (p = 0.027) toxicities. Younger women also reported more gynecologic-related toxicities (p = 0.039). Adjuvant radiation technique was associated with increased gastrointestinal- and genitourinary-related toxicities but not gynecologic-related toxicity.
  
  
  CONCLUSIONS
  Increasing BMI was associated with increased frequency of gynecologic and cutaneous radiation-associated toxicities. Additional studies to critically evaluate the radiation treatment dosing and treatment fields in obese EC patients are warranted to identify strategies to mitigate the radiation-associated toxicities in these women.
authors.affiliation: Department of Radiation Oncology, City of Hope, Duarte, CA 91010, USA.
authors.forename: Savita V
authors.initials: SV
authors.lastname: Dandapani
authors.affiliation: Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Jennelle
authors.affiliation: Department of Gynecologic Oncology, Obstetrics-Gynecology, University of Southern California, Los Angeles, CA 90033, USA ; Genentech-Roche, 1 DNA Way, MS 444B, South San Francisco, CA 94080, USA.
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D011182:Postoperative Care; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors