Management of nodal recurrences of endometrial cancer with IMRT

• Long-term survival can be achieved following IMRT for endometrial nodal recurrences.
• Patients receiving concurrent chemotherapy had improved survival and better local control.
• The use of concurrent chemotherapy and dose escalation as feasible may improve outcomes for women with isolated nodal recurrences of endometrial cancer.

ObjectivePelvic and paraortic lymph nodal regions are frequent sites of relapse in women with endometrial cancer who have not undergone adjuvant external beam radiation. We investigated outcomes after definitive management of nodal relapses of endometrial cancer with intensity modulated radiation therapy (IMRT).MethodsBetween 2002–2012, 38 patients with endometrial cancer who had no prior external beam radiation were treated definitively using IMRT for regionally confined pelvic or paraortic nodal recurrences. Thirteen (34%) had chemotherapy prior to radiation, and 21 (55%) received concurrent chemotherapy. The nodal basins were typically treated to 45–50 Gy, with a boost to the gross tumor to a median total of 64.7 Gy (range 59–73 Gy).ResultsThe median overall survival from date of recurrence was 46.1 months and the 2-year survival was 71%. Patients who received concurrent chemotherapy had a significantly longer median survival (61.9 months versus 28.7 months, p = 0.034). In-field failures were more frequent in patients who received chemotherapy prior to radiation, had a shorter recurrence-free interval, received a lower radiation dose, and had higher tumor grade. Three patients (8%) experienced grade 3–4 late gastrointestinal (GI) toxicity.ConclusionsLong-term survival can be achieved in women with nodal recurrences of endometrial cancer. The use of concurrent chemotherapy and dose escalation with IMRT as feasible may improve survival for women with isolated nodal recurrences of endometrial cancer.