Impact of postoperative intensity-modulated radiation therapy (IMRT) on the rate of bowel obstruction in gynecologic malignancy

The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT. We performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT...

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Veröffentlicht in:	Gynecologic oncology Jg. 143; H. 1; S. 18 - 21
Hauptverfasser:	Shih, Karin K., Hajj, Carla, Kollmeier, Marisa, Frey, Melissa K., Sonoda, Yukio, Abu-Rustum, Nadeem R., Alektiar, Kaled M.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Elsevier Inc 01.10.2016
Schlagworte:	Adult Aged Bowel obstruction Cervical cancer Combined Modality Therapy Endometrial cancer Female Genital Neoplasms, Female - radiotherapy Genital Neoplasms, Female - surgery Hematology, Oncology and Palliative Medicine Humans IMRT Intestinal Obstruction - epidemiology Intestinal Obstruction - etiology Middle Aged Obstetrics and Gynecology Radiotherapy, Intensity-Modulated - adverse effects Retrospective Studies Bowel obstruction IMRT Endometrial cancer Cervical cancer
ISSN:	0090-8258, 1095-6859
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Abstract	The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT. We performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT at our institution from 2000 to 2012. Patients who received definitive or palliative RT, or those with BO due to disease progression, were excluded. Standard two-sided statistical tests were used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis tests were performed for actuarial analysis. A total of 224 patients were identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT. Median follow-up time was 67months. BO was grade 1 (asymptomatic) in 2/228 (0.9%), grade 2 (conservative management) in 4 (1.8%), and grade 3≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p=0.006). Patients with BMI≥30kg/m2 were less likely to develop BO (2.6% vs. 8.3; p=0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p=0.022). The use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers. •IMRT is associated with lower rate of bowel obstruction.•Lower bowel obstruction rate was independent of other prognostic factors.•Results of this study add further credence to the role of IMRT in gynecologic cancers.
AbstractList	The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT. We performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT at our institution from 2000 to 2012. Patients who received definitive or palliative RT, or those with BO due to disease progression, were excluded. Standard two-sided statistical tests were used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis tests were performed for actuarial analysis. A total of 224 patients were identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT. Median follow-up time was 67months. BO was grade 1 (asymptomatic) in 2/228 (0.9%), grade 2 (conservative management) in 4 (1.8%), and grade 3≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p=0.006). Patients with BMI≥30kg/m2 were less likely to develop BO (2.6% vs. 8.3; p=0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p=0.022). The use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers. •IMRT is associated with lower rate of bowel obstruction.•Lower bowel obstruction rate was independent of other prognostic factors.•Results of this study add further credence to the role of IMRT in gynecologic cancers. OBJECTIVEThe purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT.METHODSWe performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT at our institution from 2000 to 2012. Patients who received definitive or palliative RT, or those with BO due to disease progression, were excluded. Standard two-sided statistical tests were used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis tests were performed for actuarial analysis.RESULTSA total of 224 patients were identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT. Median follow-up time was 67months. BO was grade 1 (asymptomatic) in 2/228 (0.9%), grade 2 (conservative management) in 4 (1.8%), and grade 3≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p=0.006). Patients with BMI≥30kg/m(2) were less likely to develop BO (2.6% vs. 8.3; p=0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p=0.022).CONCLUSIONSThe use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers. Abstract Objective The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT. Methods We performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT at our institution from 2000 to 2012. Patients who received definitive or palliative RT, or those with BO due to disease progression, were excluded. Standard two-sided statistical tests were used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis tests were performed for actuarial analysis. Results A total of 224 patients were identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT. Median follow-up time was 67 months. BO was grade 1 (asymptomatic) in 2/228 (0.9%), grade 2 (conservative management) in 4 (1.8%), and grade 3 ≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p = 0.006). Patients with BMI ≥ 30 kg/m2 were less likely to develop BO (2.6% vs. 8.3; p = 0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p = 0.022). Conclusions The use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers. The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing postoperative pelvic RT. We performed a retrospective review of all patients with endometrial or cervical cancer who received postoperative pelvic RT at our institution from 2000 to 2012. Patients who received definitive or palliative RT, or those with BO due to disease progression, were excluded. Standard two-sided statistical tests were used to evaluate for associated risk factors. Kaplan-Meier, Log rank and Cox proportional hazards regression analysis tests were performed for actuarial analysis. A total of 224 patients were identified, 120 (54%) received postoperative pelvic IMRT and 104 (46%) 3-dimentional (3-D) RT. Median follow-up time was 67months. BO was grade 1 (asymptomatic) in 2/228 (0.9%), grade 2 (conservative management) in 4 (1.8%), and grade 3≥ in 4 (1.8%). Overall, the 5-year actuarial rate of BO was 4.8%. The 5-year rate of BO in the IMRT group was 0.9% compared to 9.3% for 3-D RT (p=0.006). Patients with BMI≥30kg/m(2) were less likely to develop BO (2.6% vs. 8.3; p=0.03). On multivariate analysis, only IMRT retained its significance as an independent predictor of less BO (p=0.022). The use of postoperative IMRT for cervical and endometrial cancer was associated with significant reduction in the rate of bowel obstruction. This difference maintained its statistical significance on multivariate analysis. Such finding if confirmed by others will help further solidify the benefit of IMRT in gynecologic cancers.
Author	Sonoda, Yukio Alektiar, Kaled M. Kollmeier, Marisa Shih, Karin K. Frey, Melissa K. Abu-Rustum, Nadeem R. Hajj, Carla
AuthorAffiliation	d Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA e Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA a Gynecologic Oncology, Women's Comprehensive Health Center, Northwell Health Physician Partners, Manhasset, NY, USA c New York University Langone Medical Center, New York, NY, USA b Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
AuthorAffiliation_xml	– name: a Gynecologic Oncology, Women's Comprehensive Health Center, Northwell Health Physician Partners, Manhasset, NY, USA – name: d Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA – name: c New York University Langone Medical Center, New York, NY, USA – name: e Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA – name: b Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Author_xml	– sequence: 1 givenname: Karin K. surname: Shih fullname: Shih, Karin K. organization: Gynecologic Oncology, Women's Comprehensive Health Center, Northwell Health Physician Partners, Manhasset, NY, USA – sequence: 2 givenname: Carla surname: Hajj fullname: Hajj, Carla organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA – sequence: 3 givenname: Marisa surname: Kollmeier fullname: Kollmeier, Marisa organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA – sequence: 4 givenname: Melissa K. surname: Frey fullname: Frey, Melissa K. organization: New York University Langone Medical Center, New York, NY, USA – sequence: 5 givenname: Yukio surname: Sonoda fullname: Sonoda, Yukio organization: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA – sequence: 6 givenname: Nadeem R. surname: Abu-Rustum fullname: Abu-Rustum, Nadeem R. organization: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA – sequence: 7 givenname: Kaled M. surname: Alektiar fullname: Alektiar, Kaled M. email: alektiak@mskcc.org organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Snippet	The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing... Abstract Objective The purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies... OBJECTIVEThe purpose was to determine the potential impact of IMRT on the rate of bowel obstruction (BO), in patients with gynecologic malignancies undergoing...
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SubjectTerms	Adult Aged Bowel obstruction Cervical cancer Combined Modality Therapy Endometrial cancer Female Genital Neoplasms, Female - radiotherapy Genital Neoplasms, Female - surgery Hematology, Oncology and Palliative Medicine Humans IMRT Intestinal Obstruction - epidemiology Intestinal Obstruction - etiology Middle Aged Obstetrics and Gynecology Radiotherapy, Intensity-Modulated - adverse effects Retrospective Studies
Title	Impact of postoperative intensity-modulated radiation therapy (IMRT) on the rate of bowel obstruction in gynecologic malignancy
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