(P075) Management of Nodal Recurrences of Endometrial Cancer With IMRT

Publication
Article
OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Long-term survival can be achieved following salvage radiation for nodal recurrence of endometrial cancer. However, central and distant recurrences remain a challenge. Chemotherapy prior to radiation was associated with an increased rate of central recurrences and reduced survival, while the use of concurrent chemotherapy was associated with higher rates of survival.

Jennifer Ho, Anuja Jhingran, MD, Shannon Westin, MD, Karen Lu, MD, Patricia Eifel, Ann Klopp, MD, PhD; UT MD Anderson Cancer Center

PURPOSE: Pelvic and para-aortic lymph node regions are frequent sites of relapse in women with endometrial cancer who have not undergone adjuvant pelvic radiation. We investigated outcomes following radiation therapy with intensity-modulated radiation therapy (IMRT) for definitive treatment of nodal relapses of endometrial cancer at our institution.

MATERIALS AND METHODS: Between 2002 and 2012, a total of 42 patients with endometrial cancer who had no prior pelvic external beam radiation were treated definitively using IMRT for pelvic and/or para-aortic nodal recurrences. A total of 12 patients (29%) had pelvic nodal recurrences only, 8 (19%) had para-aortic recurrences only, 10 (24%) had simultaneous pelvic and para-aortic recurrences, and 12 (28%) had simultaneous pelvic and other regionally confined recurrences. Also, 15 patients (35%) had chemotherapy before radiation, and 21 (50%) had concurrent chemotherapy with radiation. The median size of the largest nodal recurrence site was 2.9 cm (range: 1.3–9.1 cm). The nodal basins at risk were typically treated to 45–50 Gy, with a boost to the gross tumor, for a mean total dose of 64.8 Gy (range: 59–73 Gy). Survival rates were calculated using the Kaplan-Meier method.

RESULTS: The median overall survival (OS) from date of recurrence was 45.1 months (95% confidence interval [CI], 28.3–61.8 mo), and the 2-year survival was 71%. A total of 16 (38%) patients developed local failures within the salvage radiation fields at a median time of 7.2 months (range: 2.4–28.6 mo), of which 11 were failures located within the high-dose regions. Further, 20 (48%) patients developed distant recurrences at a median time of 6.8 months (range: 1.2–31.9 mo). Patients who received concurrent chemotherapy had longer median survival than patients treated without concurrent chemotherapy (61.9 mo vs 28.9 mo; P = .029). Patients who received chemotherapy prior to radiation had shorter median survival compared with those who did not (28.3 mo vs 61.9 mo; P = .001) and a lower rate of survival free of local recurrence (28% vs 73% at 2 yr; P = .012). No significant survival difference was detected in survival or local recurrence based on histology, tumor size, or site of recurrence. A total of 11 patients (26%) experienced grade ≥ 3 gastrointestinal toxicity.

CONCLUSION: Long-term survival can be achieved following salvage radiation for nodal recurrence of endometrial cancer. However, central and distant recurrences remain a challenge. Chemotherapy prior to radiation was associated with an increased rate of central recurrences and reduced survival, while the use of concurrent chemotherapy was associated with higher rates of survival.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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