Standard Versus Intensity-Modulated Pelvic Radiation Therapy in Treating Patients With Endometrial or Cervical Cancer

Status: Recruiting
Phase: Phase 3
Diagnosis: GYN: Cervical Cancer, GYN: Endometrial/Uterine Cancer
NCT ID: NCT01672892 (View complete trial on
DFCI Protocol ID: 13-172


RATIONALE: Radiation therapy uses high-energy x-rays and other types of radiation to kill tumor cells. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. PURPOSE: This randomized phase III trial is studying two different methods of radiation and their side effects and comparing how well they work in treating endometrial and cervical cancer after surgery.


Conducting Institutions:
Brigham and Women's Hospital, Dana-Farber Cancer Institute

Overall PI:
Akila Viswanathan, MD, Brigham and Women's Hospital

Site-responsible Investigators:

Dana-Farber Cancer Institute: Christin Whalen, 617-582-7738,

Eligibility Criteria

DISEASE CHARACTERISTICS: - Pathologically proven diagnosis of endometrial or cervical cancer within 90 days of registration - Patients must have undergone a hysterectomy (total abdominal hysterectomy, vaginal hysterectomy or radical hysterectomy, or total laparoscopic hysterectomy) for carcinoma of the cervix or endometrium within 49 days prior to registration - Performance of a bilateral salpingo-oophorectomy will be at the treating surgeon's discretion - No positive or close (< 3 mm) resection margins - Appropriate stage for protocol entry, including no distant metastases, based upon the following minimum diagnostic workup: - History/physical examination within 45 days prior to registration - Computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT including the abdomen and pelvis should be performed for initial radiological staging (performed pre- or post-surgery within 90 days prior to registration) - Imaging performed postoperatively should show no evidence of residual disease - Any evidence of malignancy identified on preoperative imaging should have been completely resected surgically prior to protocol treatment - Chest x-ray or chest CT must be performed within 90 days prior to registration (unless a PET-CT has been performed) - Endometrial cancer: - Patients with the following histologic features are eligible for pelvic radiation therapy without weekly cisplatin: - Less than 50% myometrial invasion, grade 3 adenocarcinoma without uterine serous carcinoma (USC), or clear cell histology - At least 50% myometrial invasion, grade 1-2 adenocarcinoma without USC, or clear cell histology - Patients with the following histologic features may be treated with pelvic radiation with or without weekly cisplatin (the decision to add weekly cisplatin for these patients is at the treating physician's discretion): - At least 50% myometrial invasion, grade 3 including USC and clear cell carcinoma - International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrial cancer of any grade including USC and clear cell carcinoma - FIGO 2009 stage IIIC1 (pelvic lymph node positive only, para-aortic nodes sampled and negative) including USC and clear cell carcinoma - Cervical cancer: - Patients with the following pathology findings may be treated with pelvic radiation with or without weekly cisplatin at the treating physician's discretion: - Patients with intermediate-risk features including two of the following histologic findings after radical hysterectomy: 1/3 or more stromal invasion, lymph-vascular space invasion or large clinical tumor diameter (> 4 cm) - Patients with cervical cancer treated with a simple hysterectomy with negative margins - Patients with any of the following criteria following radical hysterectomy are eligible for this study and must receive weekly cisplatin: - Positive resected pelvic nodes (para-aortic nodes sampled and negative) - Microscopic parametrial invasion with negative margins - No patients with para-aortic nodal disease or who require extended-field radiotherapy beyond the pelvis - No patients with histology consisting of endometrial stromal sarcoma, leiomyosarcoma, malignant mixed mullerian tumor (MMMT), or carcinosarcoma - No evidence of metastatic disease outside of the pelvis PATIENT CHARACTERISTICS: - Zubrod performance status 0-2 - Absolute neutrophil count (ANC) ≥ 1,500 cells/mm³ - Platelets ≥ 100,000 cells/mm³ - Hemoglobin (Hgb) ≥ 8.0 g/dL (the use of transfusion or other intervention to achieve Hgb ≥ 8.0 g/dL is acceptable) - For patients receiving chemotherapy: - Within 14 days prior to registration, serum creatinine ≤ 1.5 mg/dL AND calculated creatinine clearance ≥ 50 mL/min - Aspartate aminotransferase (AST) ≤ 2 times upper limit of normal (ULN) - Bilirubin ≤ 2 times ULN - Alkaline phosphatase, magnesium, blood urea nitrogen (BUN), and electrolytes must be obtained and recorded - Fertile patients must use effective contraception - Not pregnant and/or breastfeeding - Willing and able to complete the bowel and urinary domains of the expanded prostate cancer index composite (EPIC) instrument prior to registration - No patients who exceed the weight/size limits of the treatment table or CT scanner - No mental status changes or bladder control problems that make the patient unable to comply with bladder-filling instructions - No prior invasive malignancy (except non-melanomatous skin cancer) unless disease-free for a minimum of 3 years - No patients with active inflammatory bowel disease - No severe, active co-morbidity, defined as follows: - Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months - Transmural myocardial infarction within the last 6 months - Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration - Other major medical illness that requires hospitalization or precludes study therapy at the time of registration - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects (however, laboratory test coagulation parameters are not required for entry into this protocol) - Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition (however, human immunodeficiency virus [HIV] testing is not required for entry into this protocol) PRIOR CONCURRENT THERAPY: - See Disease Characteristics - No prior radiation therapy to the pelvis - No prior treatment with platinum-based chemotherapy - Patients may NOT receive amifostine or other protective reagents
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