Whole-abdominal radiation in endometrial carcinoma: An analysis of toxicity, patterns of recurrence, and survival

PURPOSE The purpose of this study was to determine the toxicity, patterns of recurr ence, and survival in high-risk endometrial cancer patients treated with wh ole-abdominal radiation. MATERIALS AND METHODS Ail patients with endometrial cancer treated at Northwestern University sin ce 1994 and at Rush University since 1993 were retrospectively reviewed. Pa tients believed to be at high risk for intra-abdominal recurrence and who r eceived whole-abdominal radiation were reviewed for this study. RESULTS A total of 30 patients completed whole-abdominal radiation (WAR) and were a vailable for study. The mean and median followup was 2.3 and 2.1 years, res pectively, with a range of 0.13 to 6.1 years. Seventy-eight percent of the cohort received surgical staging with bilateral salpingo-oophorectomy/total abdominal hysterectomy/lymph node sampling. Forty-seven percent of the pat ients were found to have serous histology as a component of their tumor. Su rgical staging results included 19% stage 1B, 4% stage IC, 8% stage IIB, 37 % stage IIIA, 26% stage IIIC, and 7% stage IVB. Two patients had gross resi dual disease at the completion of surgery. Megestrol acetate (Megace) was u sed as an adjuvant treatment in 37% of patients, and no cases received init ial chemotherapy. All patients received WAR with a mean total dose and dose per fraction of 2620 and 143 cGy, respectively. Twenty-two percent of pati ents received a para-aortic boost. The mean total pelvic dose was 4956 cGy. Seventy percent of patients received a vaginal cuff boost. Eight percent o f patients had grade 3 acute gastrointestinal morbidity, and 4% had grade 4 acute gastrointestinal morbidity. No other grade 3 or greater acute or lon g-term morbidity was noted. At last follow-up, seven (23%) patients had exp erienced recurrence. The pattern of first recurrence was 0% in the vaginal cuff, 3% other vaginal, 7% pelvic, 7% upper abdominal, 3% lung, 7% bone, an d 7% para-aortic lymph nodes. Ultimate recurrences were similar. At last fo llowup, 77% patients had no evidence of disease, 13% were alive with diseas e, and 10% had died of disease. CONCLUSIONS Utilizing a conservative total whole-abdominal radiation dose and limited p araaortic nodal boost resulted In very tolerable treatments. The patterns o f recurrence and survival in this early report are encouraging.