Postoperative radiotherapy for Stage 1 endometrial carcinoma: Long-term outcome of the randomized PORTEC trial with central pathology review

Scholten, Astrid N.; Putten, Wim L.J. van; Beerman, Herman; Smit, Vincent T.H.B.M.; Koper, P.; Lybeert, Marnix L.M.; Jobsen, Jan J.; Wárlám-Rodenhuis, Carla C.; Winter, K. De; Lutgens, Ludy; Lent, M. van; Creutzberg, Carien L.

doi:10.1016/j.ijrobp.2005.03.007

Cited by 228 publications

(140 citation statements)

References 7 publications

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“…Concurrent radiotherapy with cisplatin‐based chemotherapy has become the standard treatment for early stage cervical cancer patients with positive pelvic nodes and/ or positive surgical margin and/ or positive parametrium according to the National Comprehensive Cancer Network (NCCN) guidelines 2, 3. Postoperative whole pelvic conformal radiotherapy (CRT) has become the standard of care for patients meeting specific criteria thanks to multiple phase III trials showing the benefit of pelvic radiation on reducing the risk of pelvic recurrence in patients with a high‐risk pathologic feature 4, 5…”

Section: Introductionmentioning

confidence: 99%

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Deng

Han

Chen³

et al. 2016

J Applied Clin Med Phys

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As the advantage of using complex volumetric‐modulated arc therapy (VMAT) in the treatment of gynecologic cancer has not yet been fully determined, the purpose of this study was to investigate the dosimetric advantages of VMAT by comparing directly with whole pelvic conformal radiotherapy (CRT) and intensity‐modulated radiotherapy (IMRT) in the treatment of 15 postoperative cervical cancer patients. Four‐field CRT, seven‐field IMRT, and two‐arc VMAT plans were generated for each patient with identical objective functions to achieve clinically acceptable dose distribution. Target coverage and OAR sparing differences were investigated through dose‐volume histogram (DVH) analysis. Nondosimtric differences between IMRT and VMAT were also compared. Target coverage presented by V95% were 88.9% ± 3.8%, 99.9% ± 0.07%, and 99.9% ± 0.1% for CRT, IMRT, and VMAT, respectively. Significant differences on conformal index (CI) and conformal number (CN) were observed with CIs of 0.37 ± 0.07, 0.55 ± 0.04, 0.61 ± 0.04, and CNs of 0.33 ± 0.06, 0.55 ± 0.04, 0.60 ± 0.04 for CRT, IMRT, and VMAT, respectively. IMRT and VMAT decreased the dose to bladder and rectum significantly compared with CRT. No significant differences on the Dmean, V45, and V30 of small bowel were observed among CRT, IMRT, and VMAT. However, VMAT (10.4 ± 4.8 vs. 19.8 ± 11.0, P = 0.004) and IMRT (12.3 ± 5.0 vs. 19.8 ± 11.0, P = 0.02) decreased V40, increased the Dmax of small bowel and the irradiation dose to femoral heads compared with CRT. VMAT irradiated less dose to bladder, rectum, small bowel and larger volume of health tissue with a lower dose (V5 and V10) compared with IMRT, although the differences were not statistical significant. In conclusion, VMAT and IMRT showed significant dosimetric advantages both on target coverage and OAR sparing compared with CRT in the treatment of postoperative cervical cancer. However, no significant difference between IMRT and VMAT was observed except for slightly better dose conformity, slightly less MU, and significant shorter delivery time achieved for VMAT.

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Section: Introductionmentioning

confidence: 99%

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Deng

Han

Chen³

et al. 2016

J Applied Clin Med Phys

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“…Treatment related complications were more common in the radiotherapy group compared to the control group (25% vs. 6%, p<0.001). Scholten et al published a 10-year follow-up of PORTEC-1, which excluded cases downgraded after central pathology review (Scholten et al 2005). Similar to the original study, the 10-year loco-regional relapse rate was significantly higher in the no further treatment group compared to the RT group (14% vs. 5%, p>0.001).…”

Section: Low-risk Patientsmentioning

confidence: 78%

Treatment Strategies and Prognosis of Endometrial Cancer

Garg¹,

Mutch²

2012

Cancer of the Uterine Endometrium - Advances and Controversies

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“…The recent Dutch PORTEC trial included an analysis of survival after vaginal relapse of endometrial carcinoma and showed that, after vaginal recurrence, the 5-year survival rate was only 65 % when relapsed patients were treated curatively with RT and/or surgery [13]. GOG-99 found that 5 (38 %) of 13 patients with vaginal recurrence after surgery (in the no-radiation arm) died as a result of their endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Six Years Analysis of Survival and Late Morbidity of Post-operative Gynaecological Malignancy Treated with External Radiotherapy Followed by Brachytherapy in Medical College & Hospitals, Kolkata

Ghosh

Mitra

et al. 2013

J Obstet Gynecol India

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Background Cervical and endometrial carcinoma incidentally found in the surgical specimen with high risk pathological finding or with gross residual disease. Material and Methods Between 2004 and 2010, 320 cervical and endometrial cancer patients were treated with EBRT and brachytherapy after having undergone total/ subtotal hysterectomy. Sixty patients were lost to followup. Results Median follow-up was 21 months. Endometrial and cervical cancer with a high risk for local recurrence achieved CR 93.8 and 89 %, respectively. 56 % patients experienced CR with residual disease with cervical cancer. Median OS for endometrial and cervical cancer with residual disease was 8.5 and 24 months, respectively. Grade 3 adverse events were 5 and 3.5 % for rectum and bladder, respectively. Conclusion The incorporation of chemotherapy during pelvic radiotherapy followed by HDR interstitial brachytherapy for residual disease is inadequate and improves survival. We are still in learning phase of brachytherapy in post-operative gynaecological malignancy cases; expertise will be developed by practice.

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Postoperative radiotherapy for Stage 1 endometrial carcinoma: Long-term outcome of the randomized PORTEC trial with central pathology review

Cited by 228 publications

References 7 publications

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Treatment Strategies and Prognosis of Endometrial Cancer

A Retrospective Six Years Analysis of Survival and Late Morbidity of Post-operative Gynaecological Malignancy Treated with External Radiotherapy Followed by Brachytherapy in Medical College & Hospitals, Kolkata

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