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Whole abdominal irradiation in endometrial cancer - a single institution study
1Department of Radiotherapy, University Hospital Queen Giovanna-ISUL, Sofia, Bulgaria. lgocheva2001@yahoo.co.uk
Purpose:
To examine the use of whole abdominal irradiation (WAI) open field technique in patients with stage III endometrial cancer (EC).
Methods:
Between 1993 and 2007, 26 patients (age 39-70 years, median 58) with stage III EC (IIIA 15, IIIB 2, IIIC 8) were treated with WAI after primary surgery. Five (21)) patients had grade 1 disease, 18 (67%) grade 2 and 3 (12%) grade 3. In 2 (8%) patients a second laparotomy was carried out before the radiotherapy (RT) referral. Ascites and positive peritoneal cytology was present in 3 (15%) and 4 (20%) patients, respectively. After surgery, residua < 2 cm in the upper abdomen were left in 2 patients. WAI was delivered using Co 60 anterior-posterior photon fields to encompass the peritoneal cavity. In 84% of the patients WAI consisted of 30 Gy, delivered mainly in daily fractions of 1.5 Gy (81%), 5 fractions per week. For the remaining patients the dose was 25 Gy (8%) and 20 Gy (8%), respectively. After abdominal RT, 85% of the patients were given a pelvic boost to reach 45 - 50 Gy with 1.8 Gy/fraction/day, using a Co 60 unit. In 5 (19%) patients boost to 45-50 Gy with 1.8 Gy/fraction/day to other risk sites was also given. Two (8%) of 26 patients received 2 cycles of platinum-based chemotherapy. The mean follow-up time was 13.41 years.
Results:
The treatment time ranged from 14-74 days, median 48. The overall survival (OS) rate was 93% at 5, 10 and 14 years. Ten (38.5%) patients received their treatment with no interruption, and in 16 (61.5%) patients RT was transiently interrupted because of acute gastrointestinal and hematological toxicity. Neither grade 4 acute complications nor mortality while receiving treatment were observed. Late side effects (grade 2 gastrointestinal complications) developed in 1 (5%) patient. During the observation period a second primary malignancy was recorded in 1 patient.
Conclusion:
WAI achieves a quite favorable 5- and 14-year survival rate with an acceptable risk of acute and late side effects in properly selected patients with stage III EC. WAI as a sole or a part of combined treatment warrants further investigation in patients with high-risk EC.
