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Abstract: Objectives. : To assess the acute tolerance of delivering concurrent cisplatin and extended field radiotherapy (EFRT) using intensity-modulated radiotherapy technique (IMRT) for cancer of the cervix. Methods. : All patients receiving definitive treatment for cervical cancer were treated with EFRT using IMRT technique and concurrent cisplatin. The treatment volume included the cervix, uterus, parametria, presacral space, upper vagina, pelvic, common iliac, and paraaortic nodes to the top of L1. All regions received 45 Gy (25 fractions) with a simultaneous boost to involved nodes (55 Gy/25 fractions). Patients were assessed weekly for toxicity and response. Results. : Twenty-two consecutive patients underwent treatment. All patients completed the prescribed course of EFRT. Median treatment length was 39.5 days (range 36–53). Treatment breaks of 2 and 3 days were required for bone marrow toxicity in 2 patients. The final week of chemotherapy was held in 2 patients because of neutropenia. No patient suffered acute or subacute grade 3 or 4 GI or GU toxicity. Conclusion. : In this clinical study, an IMRT technique was used to successfully deliver EFRT with concurrent chemosensitization for cervical cancer. The technique was associated with an acceptable acute toxicity without significant treatment protraction. This new role for IMRT merits further evaluation with larger patient numbers and longer follow-up. [Copyright &y& Elsevier]

Commentary On: Spratt DE, Arevalo-Perez J, Leeman JE, Gerber NK, Folkert M, Taunk NK, et al. Early magnetic resonance imaging biomarkers to predict local control after high dose stereotactic body radiotherapy for patients with sarcoma spine metastases. Spine J 2016:16:291-98 (in this issue). [ABSTRACT FROM AUTHOR]

Abstract: Objective. : To assess local control and chronic toxicity with IMRT for adjuvant treatment of endometrial carcinoma. Methods. : Forty-seven patients with endometrial cancer were treated with adjuvant IMRT and HDR brachytherapy (HDRB). The external beam dose was between 45 and 50.4 Gy, and all patients received 10 Gy in 2 fractions of HDRB to the vaginal cuff. Eight of these patients were treated with extended field to include the paraaortic region. Results. : IMRT dosimetry showed excellent coverage of the planning target volume (PTV) with mean PTV 95, PTV 110 and PTV 120 of 97.8%, 8.2% and 0.9% respectively. At a median follow-up of 20 months, four patients have recurred at extra pelvic sites. No patient had pelvic recurrence. The treatment was well tolerated with late toxicities as follows: small bowel grade 1: 25%, rectal grade 1: 2% and bladder grade 1: 13%. One patient had grade 3 small bowel toxicity. The 3-year actuarial rate of grade 2 or greater toxicity, disease-free survival and overall survival rate were 3.3%, 84% and 90%, respectively. Conclusions. : The preliminary analysis of IMRT for adjuvant treatment of endometrial carcinoma shows excellent local control and low toxicity. However, longer follow-up and more patients are needed to ascertain whether the benefits of IMRT treatment seen here translate into long-term reductions in toxicities and local recurrence. [Copyright &y& Elsevier]