title: Safety of adjuvant intensity-modulated postoperative radiation therapy in endometrial cancer: Clinical data and dosimetric parameters according to the International Commission on Radiation Units (ICRU) 83 report.
abstract: OBJECTIVE
  To report a single-institution experience using postoperative pelvic Intensity Modulation Radiation Therapy (IMRT) using tomotherapy accelerators (TA) in postoperative endometrial cancer (EC) regarding ICRU 83 recommendations.
  
  
  BACKGROUND
  IMRT in gynecological malignancies provides excellent dosimetric data, lower rates of adverse events and clinical data similar to historical series.
  
  
  METHODS
  Seventy-six patients with EC were postoperatively treated with adjuvant IMRT using TA. The IMRT dose was 45 Gy for patients without positive lymph nodes and Type I histology and 50.4 Gy for patients with positive lymph nodes and/or type II histology.
  
  
  RESULTS
  With a median follow-up of 29 months, the 12- and 24-month Overall Survival (OS) and Disease-Free Survival (DFS) were 96%, 93%, 87%, and 74%, respectively. Age of less than 60 years was associated with better OS (HR: 8.9; CI: 1.1-68) and DFS (HR: 3.5; CI: 1.2-10.2). Patients with Type II and Type I Grade III histology had a worse OS (HR: 3.3; CI: 1.1-11). Five women (6.6%) presented in-field local vaginal recurrence, 2 (2.6%) presented non-in-field vaginal recurrence, 4 (5.2%) presented pelvic node and distant recurrence and 11 (14.4%) presented only distant metastases. One patient stopped radiation treatment due to Grade III acute diarrhea. No Grade III late toxicity was observed. Planning Target Volume (PTV) coverage showed mean D2, D50, D95, and D98 of 51.64-46.23 Gy, 49.49-44.97 Gy, 48.62-43.96 Gy, and 48.47-43.58 Gy for patients who received 45 and 50.4 Gy, respectively.
  
  
  CONCLUSIONS
  IMRT with TA in postoperative EC shows excellent conformity and homogeneity of PTV dose. Without Grade III late toxicity, data from this cohort demonstrated the utility of IMRT.
authors.affiliation: Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Abel
authors.initials: A
authors.lastname: Cordoba
authors.affiliation: Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Nickers
authors.affiliation: Department of Statistic, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Tresch
authors.affiliation: Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Castelain
authors.affiliation: Department of Surgery, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.affiliation: Department of Surgery, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Narducci
authors.affiliation: Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Le Tinier
authors.affiliation: Department of Clinical Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Lesoin
authors.affiliation: Department of Radiation Physics, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lacornerie
authors.affiliation: Department of Radiation Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lartigau
keywords: Endometrial cancer; ICRU83; IMRT; Tomotherapy