Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_21_3525 - Toxicity and clinical outcomes in patients with uterine cancer treated with adjuvant intensity modulated radiation therapy and vaginal brachytherapy (IMRT+VB) "sandwiched" between combination paclitaxel and carboplatin

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Toxicity and clinical outcomes in patients with uterine cancer treated with adjuvant intensity modulated radiation therapy and vaginal brachytherapy (IMRT+VB) “sandwiched” between combination paclitaxel and carboplatin
A. Pirlamarla1, K. J. Mehta2, S. Viswanathan2, S. Kalnicki1, and D. Kuo3; 1Albert Einstein College of Medicine, Bronx, NY, 2Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 3Montefiore Medical Center, Bronx, NY

Purpose/Objective(s): The IMRT technique for uterine cancer helps to lower dose to organs at risk, especially the bone marrow. PORTEC-2 also showed comparable outcomes of VB alone compared to external pelvic RT for high-intermediate risk patients. Few reports examine the combination of IMRT+VB, especially in the setting of chemotherapy for advanced patients. Here, we look at the long-term effects of adjuvant IMRT+VB “sandwiched” between carboplatin and paclitaxel chemotherapy (C-T Cx).

Materials/Methods: We reviewed 206 patients treated with adjuvant IMRT+VB and sandwich chemotherapy for Stage I-III uterine cancer from 2009 - 2016. Patients were surgically staged with no visible residual disease. Chemotherapy regimen involved C-T Cx every 21 days for 3 cycles, followed by IMRT+VB, followed by 3 additional cycles of C-T Cx. Patients were to have received at least one cycle post-RT to be included. Toxicities were graded with CTCAE, version 4.03. Rates for local control (LC), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS) were examined using Kaplan-Meier survival curves.

Results: Median age and follow-up was 70 years (range: 36-94) and 39 months (range: 6.23-110.1 months), respectively. Ethnicity distribution was 48% African-American, 31% Hispanic, 17% White, 4% Asian, and 1% other. Histological type revealed 42% EAC, 40% UPSC, and 18% CS. FIGO stage distribution: IA-30%, IB-15%, II-16%, IIIA-7%, IIIB-15%, IIIC1-18%, and IIIC2-12%. Grade distribution: 1 – 9.7%, 2 – 8.7 %, 3 – 80.6%. LVSI was present in 51.5% of patients. Twenty-four (12%) patients underwent extended-field IMRT. Acute grade 2 and 3 GI toxicity was present in 17 (8.3%) and 4 (1.9%) patients, respectively. Two (1.0%) patients had acute grade 2, but none had grade ≥3 GU toxicity. Acute grade ≥3 neutropenia, anemia, and thrombocytopenia were present in 33.5%, 10.7%, and 11.7%, respectively. Late grade 2 and 3 GI toxicity was in 8 (3.9%) and 7 (3.4%) patients, respectively, including one with a colovesicular fistula. Five (2.4%) had late grade 2 but none had grade ≥3 GU toxicity. A large portion (21.4%) had grade 1 vaginal stenosis (VS), followed by grades 2 (9.2%) and 3 (1.0%). Stages I-II and III had similar five-year rate of LC (95.2% vs. 91.4%; logrank p=0.94) but significantly different DM rate (22.0% vs 49.6%; logrank p=0.002). Stages I-II and III had significantly different DFS (76.7% vs. 48.9%; logrank p=0.0012) but similar OS (86.0% vs. 85.7%; logrank p=0.79). Compared to EAC, CS was significantly more likely to have worse OS (HR: 7.65, 95% CI 1.53-38.4; p=0.013), DFS (HR: 3.83, 95% CI 1.80-8.15; p=0.0005), and DM rate (HR: 4.27, 95% CI 1.96-9.30; p=0.0003). Although not statistically significant, UPSC trended towards inferior OS (p=0.09) compared to EAC.

Conclusion: This study represents the largest cohort of uterine cancer patients receiving adjuvant IMRT+VB “sandwiched” between chemotherapy. Patients have good long-term clinical outcomes and a low toxicity profile.

Author Disclosure: A. Pirlamarla: None. K.J. Mehta: Advisory Board; Sirtex. S. Viswanathan: None. S. Kalnicki: Travel Expenses; Varian Oncology Systems. Committee Member; American College of Radiology. D. Kuo: None.

Send Email for Aneesh Pirlamarla


Assets

TU_21_3525 - Toxicity and clinical outcomes in patients with uterine cancer treated with adjuvant intensity modulated radiation therapy and vaginal brachytherapy (IMRT+VB) "sandwiched" between combination paclitaxel and carboplatin



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Toxicity and clinical outcomes in patients with uterine cancer treated with adjuvant intensity modulated radiation therapy and vaginal brachytherapy (IMRT+VB) "sandwiched" between combination paclitaxel and carboplatin