title: Preoperative high dose rate brachytherapy for clinical stage II endometrial carcinoma.
abstract: OBJECTIVE
  We sought to evaluate pathological response, tolerance, and outcome after preoperative (neoadjuvant) high dose rate brachytherapy in a small series of patients with clinical stage II endometrial carcinoma, and to evaluate a dose and fractionation protocol for this treatment.
  
  
  METHODS
  Twelve women diagnosed with clinical stage II endometrial carcinoma from 1999-2010 were treated with preoperative radiation therapy. Their medical charts were retrospectively analyzed for HDR treatment regimen, pathological response, and longitudinal outcomes. Radiation doses were normalized to a biologically equivalent dose of 2 Gy per fraction (EQD2).
  
  
  RESULTS
  Two patients had complete pathological response to neoadjuvant therapy; five more had only microscopic residual disease at the time of surgery. At a median follow up of 37 months (1-91 months), one patient has developed recurrence at the vaginal apex six months after completing initial therapy, while another developed a lung recurrence at 28 months. Two-year disease-free and cause-specific survivals were 88% and 100%, respectively.
  
  
  CONCLUSIONS
  Our small study shows that the HDR fractionation schedule, as done in our series for preoperative radiation therapy for clinical stage II endometrial cancer, is well tolerated and would be an option for patients treated with neoadjuvant radiation therapy.
authors.affiliation: University of Pittsburgh School of Medicine.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Shukla
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute.
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
authors.affiliation: Department of Gynecologic Oncology, University of Pittsburgh Medical Center, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.affiliation: Department of Gynecologic Oncology, University of Pittsburgh Medical Center, USA.
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.affiliation: Department of Gynecologic Oncology, University of Pittsburgh Medical Center, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.affiliation: Department of Gynecologic Oncology, University of Pittsburgh Medical Center, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Richard
authors.affiliation: Department of Gynecologic Oncology, University of Pittsburgh Medical Center, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Olawaiye
authors.affiliation: Department of Gynecologic Oncology, University of Pittsburgh Medical Center, USA.
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Zorn
keywords: HDR brachytherapy; endometrial carcinoma; neoadjuvant; radiation