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Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of... Background: Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case: We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. Conclusion: IMRT is a valid technique to prevent the kidney from radiation damage. while protecting normal tissues in an attempt to reduce Background Randomized trials have shown that Pelvic Radiotherapy the incidence and severity of side effects. (RT) as a postoperative treatment for intermediate and high risk endometrial cancer improves local regional con- Patient history trol. Its impact on overall survival is still unknown. Intra- A 50-year old Caucasian woman was referred to the Radi- cavitary Brachytherapy also improves vaginal control. ation Oncology Department of Hospital do Cancer A C Both treatments, however, imply significant side effects Camargo, São Paulo, Brazil, with Endometrial Cancer. that a fine technique can help avoiding. Intensity Modu- Due to bilateral ovary mass she was submitted to explora- lated RT (IMRT) is the most efficient external beam RT tory laparotomy. During the surgical procedure, Total delivery technique nowadays. Using a high gradient of Abdominal Hysterectomy and Bilateral Salpingectomy radiation dose enables the treatment of the target volume and Oophorectomy (TAH/BSO) were performed. The Page 1 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 pathological analysis revealed a mucinous cystic adenoma function, both by serum panel and isotopic nephrogram in her left ovary and an endometrioid cyst in her right evaluation. The nephrogram did not show any changes ovary (no evidence of malignancy). The endometrium compared to the initial exam. presented a solid, Serous Papiliferous Adenocarcinoma, poorly differentiated, compromising the inner half of the Discussion myometrium with extension to the upper endocervix. Patients with a pelvic kidney should not receive RT unless There was no lymph vascular space invasion and the mar- it is a mainstream in the treatment of that type of tumor. gins were not compromised. There are very few reports on treating pelvic kidneys She was classified as IIA by FIGO criteria [1] and received patients with EBRT [2-8]. 6 cycles of Carboplatin and Paclitaxel, followed by 29 Gy of High Dose Rate Brachytherapy (HDR BT) prescribed on It is important to establish the need, and the benefits of RT the vaginal surface, divided in 4 fractions, with median to any patient with in such a condition. dose to the rectum and bladder reference points of respec- Pelvic kidney function tively 48 and 58%. We used renal blood tests and isotopic nephrogram to She was referred to our Institution because she had a Con- access the patient's renal function. The scintigrafic study genital Pelvic Kidney. used static and dynamic assessment of glomerular and tubular function. Her right pelvic kidney took 45% of the Static and dynamic Scintigrafic renal function studies were radio labeled marker (DMSA/DTPA), and had normal performed. They showed that the pelvic kidney was func- excretion of it. Eighteen months after the treatment the tioning perfectly – it absorbed 45% of the injected radio- kidney' uptake was unchanged. active isotope. Scintigraphic renograms have correlated with biochemical A study plan for IMRT was led. It showed the dose to nor- and clearance end points [9], and are adequate for this sit- mal tissue and kidney was kept under tolerable limits. The uation, as the other kidney is functioning well, and any patient was informed of the risks and benefits of proceed- effect on the pelvic kidney would be better seen with func- ing with the treatment. The prescribed dose to cover 95% tional images rather than with functional biochemical of the target volume (whole pelvic drainage and vaginal exams. vault) was 45 Gy at 1.8 Gy per fraction. Benefit of adjuvant radiation and chemotherapy Seven co-planar fields were chosen at an interval rotation The standard surgical treatment for uterine neoplasia con- of 50 degrees. Dynamic Multileaf Collimation was used. sists of Radical Hysterectomy, bilateral salpingo The target volume excluded the entire pelvic kidney and oophorectomy, and lymphadenectomy or lymph node covered pelvic lymphatics from L5 down. sampling. RT field fluency is presented in figure 1, and Dose Distri- In this case, the surgical approach was not radical in intent bution is presented in figure 2. The dose volume analysis because the uterine neoplasia was an incidental finding. (DVH) is presented in figure 3. Therefore, the lymph node status was not known. In this setting, the benefit of re-operation is unclear and not evi- Planned dose distribution was verified dosimetrically and dence-based. The prospective PORTEC trial [10] has matched the software's calculation. The qualitative analy- directly tested the benefit of RT for patients without sis of isodose curves was satisfactory too. lymph node information. Patients with endometrial ade- nocarcinoma were randomized to receive postoperative During treatment, the patient presented peri-anal radio- pelvic EBRT, or no adjuvant therapy. They noticed a signif- dermitis (RTOG grade 1), increased bowel movements icant advantage in pelvic control for the adjuvant treat- (up to 3 times/day), and a lowering in platelet count lev- ment arm with risk features (deep myometrial invasion, els (75,000/mm3) which led to a 7 day treatment inter- cervical canal extension, high grade histology, or lymph ruption at 37.8 Gy. She subsequently recovered with a vascular space invasion), though not translated into sur- platelet rise to 90,000/mm3 and the treatment was vival benefit. The majority of failures occurred at the vag- resumed. The renal function panel was unaltered during inal vault. This study did not evaluate specifically serous the whole RT course. papiliferous tumors, but this subset of tumors is known to have a worse prognosis. This patient is classified as having When last seen – 18 months after the end of RT – the a high risk tumor. It is considered a non- endometrioid patient was free from disease. She had normal kidney tumor, not responsive to estrogenic castration. Metha and Page 2 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 Ra Figure 1 diation fluence Radiation fluence. shows radiation fields, their fluence maps, and the resulting dose distribution on a section plane that includes the pelvic kidney. cols [11] have studied a group of women with stage I-II Expected risks, side effects, and tolerance serous papiliferous tumors treated with surgery followed Kidney tolerance to radiation dose highly depends on the or not by adjuvant therapy. Though no variables were sta- irradiated volume. tistically correlated to prognosis, out of 13 women who did not receive RT/BT, 5 recurred in the pelvis (4 in the Tolerance dose for a 5% chance of late adverse effect at 5 vagina, 1 in the lateral pelvis). In contrast, none of the years is estimated to be 50 Gy for one third of the kidney, patients who received RT/BT (total of 10) recurred in the 30 Gy for two thirds, and 23 Gy for the whole kidney [12]. pelvis. The 5-year pelvic recurrence free survival was 100 It increases to 50% late toxicity if two thirds are irradiated vs. 57%, with a p = 0.06. to a dose of 40 Gy or one third to a dose of 28 Gy. This information and other published results suggesting a As noted on the DVH (figure 3) these parameters have benefit of carboplatin/paclitaxel based chemotherapy for been respected in the present case. this histological type and the fact that this histological type of tumor carries a high risk of recurrence makes us The literature does not define the optimal treatment for believe that our patient did benefit from the adjuvant patients with pelvic kidneys who need to undergo pelvic chemo-radiotherapy, including vaginal vault BT. RT. We could find 7 case reports concerning this subject Page 3 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 Dose distribution Figure 2 Dose distribution. shows the dose distribution for the 45 Gy prescribed dose. [2,4-8]. In 5 cases the primary tumor being treated was a RT fields, and properly match the dose distribution to the uterine cervix carcinoma [2,6-8]. In 3 of them, the kidney CT visible tumor, while evaluating dose received by nor- was transplanted outside the pelvis, away from the RT tar- mal tissue, therefore predicting treatment tolerance. It is get volume [2,7,8]. However, there was significant mor- however limited in achieving these goals when the tumor bidity related to the procedure, especially regarding the is surrounded by normal tissues with low radiation resist- graft vasculature, and the urinary tract. In one case an ade- ance, or when the normal organ is in the middle of the RT nocarcinoma of the uterine cervix in a transplanted port. In this setting IMRT has been shown effective, and its patient was treated initially with Intracavitary BT (low use for head and neck, thoracic, and abdominal treat- dose rate) followed by a modified field pelvic RT protect- ments have been increasing. ing the kidney, but partially compromising the RT target volume [6]. This patient relapsed on the border of the RT We showed that IMRT is also a good alternative in such a field. complex situation. It has prevented the patient from undergoing an auto-transplantation procedure. Other reports of auto-transplantation followed by RT for inguinal-pelvic irradiation in a vulvar cancer patient, and During treatment, this patient presented mild (common for adjuvant treatment of a stage III operated rectal aden- toxicity criteria grade 1) platelet complication. Lately ocarcinoma exists [4,5]. there has been an increase in the use of IMRT to spare the blood marrow, providing that, in case of a relapse and Although the preferred approach has not been estab- need for new chemotherapy regimens, maintaining as lished, no report exists on the use of high technology RT much functioning marrow as possible presents another in an attempt to accomplish an adequate plan without advantage of using IMRT. Roeske and cols have shown the moving the kidney out of the RT field. Conformal 3D RT main location of blood elements production in the pelvis has been developed to precisely study the combination of Page 4 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 D Figure 3 ose Volume Histogram Dose Volume Histogram. shows the graphic of Dose Volume Histogram. The curves show the distribution for the PTV, rectum, bladder, intestines, pelvic kidney and left topic kidney. 5. DeRoover A, Verni MP, Taylor RJ: Renal allograft autotransplan- [13], and it is possible to define these points as dose tation before pelvic irradiation. Transplantation 2000, restriction points for the IMRT planning. 70:844-846. 6. Ripley D, Levenback C, Eifel P, Lewis RM: Adenocarcinoma of the cervix in a renal transplant patient. Gynecol Oncol 1995, To our knowledge, this is the first report on the use of 59:151-155. IMRT to spare a pelvic kidney without compromising a 7. Rosenshein NB, Lichter AS, Walsh PC: Cervical cancer compli- cated by a pelvic kidney. J Urol 1980, 123:766-767. pelvic RT plan. 8. Roth TM, Woodring CT, McGehee RP: Stage II-B carcinoma of the cervix complicated by bilateral pelvic kidneys. Gynecol IMRT was a valid radiation technique to keep the pelvic Oncol 2004, 92:376-379. 9. Dewit L, Anninga JK, Hoefnagel CA, Nooijen WJ: Radiation injury kidney dose under acceptable dose volume constraints in the human kidney: a prospective analysis using specific without compromising the target volume. scintigraphic and biochemical endpoints. Int J Radiat Oncol Biol Phys 1990, 19:977-983. 10. Scholten AN, van Putten WL, Beerman H, Smit VT, Koper PC, IMRT should be considered an option for treating pelvic Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, De Winter KA, Lut- fields in patients who present a pelvic kidney. gens LC, van Lent M, Creutzberg CL: Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology References review. Int J Radiat Oncol Biol Phys 2005, 63:834-838. 1. Benedet JL, Bender H, Jones H III, Ngan HY, Pecorelli S: FIGO stag- 11. Mehta N, Yamada SD, Rotmensch J, Mundt AJ: Outcome and pat- ing classifications and clinical practice guidelines in the man- tern of failure in pathologic stage I-II papillary serous carci- agement of gynecologic cancers. FIGO Committee on noma of the endometrium: implications for adjuvant Gynecologic Oncology. Int J Gynaecol Obstet 2000, 70:209-262. radiation therapy. Int J Radiat Oncol Biol Phys 2003, 57:1004-1009. 2. Abouna GM, Micaily B, Lee DJ, Kumar MS, Jahshan AE, Lyons P: Sal- 12. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank vage of a kidney graft in a patient with advanced carcinoma B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeu- of the cervix by reimplantation of the graft from the pelvis tic irradiation. Int J Radiat Oncol Biol Phys 1991, 21:109-122. to the upper abdomen in preparation for radiation therapy. 13. Roeske JC, Lujan A, Reba RC, Penney BC, Diane YS, Mundt AJ: Incor- Transplantation 1994, 58:520-522. poration of SPECT bone marrow imaging into intensity 3. Bakri YN, Mansi M, Sundin T: Stage IIB carcinoma of the cervix modulated whole-pelvic radiation therapy treatment plan- complicated by an ectopic pelvic kidney. Int J Gynaecol Obstet ning for gynecologic malignancies. Radiother Oncol 2005, 1993, 42:174-176. 77:11-17. 4. Bokhari MB, Hostetter RB, Auber ML, Ulewicz DE: Locally advanced rectal cancer with a pelvic kidney complicating adjuvant radiation therapy. J Surg Oncol 1996, 63:57-60. Page 5 of 5 (page number not for citation purposes) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiation Oncology Springer Journals

Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

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Publisher
Springer Journals
Copyright
Copyright © 2006 by Castilho et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; Oncology; Radiotherapy
eISSN
1748-717X
DOI
10.1186/1748-717X-1-44
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17116263
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Abstract

Background: Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case: We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. Conclusion: IMRT is a valid technique to prevent the kidney from radiation damage. while protecting normal tissues in an attempt to reduce Background Randomized trials have shown that Pelvic Radiotherapy the incidence and severity of side effects. (RT) as a postoperative treatment for intermediate and high risk endometrial cancer improves local regional con- Patient history trol. Its impact on overall survival is still unknown. Intra- A 50-year old Caucasian woman was referred to the Radi- cavitary Brachytherapy also improves vaginal control. ation Oncology Department of Hospital do Cancer A C Both treatments, however, imply significant side effects Camargo, São Paulo, Brazil, with Endometrial Cancer. that a fine technique can help avoiding. Intensity Modu- Due to bilateral ovary mass she was submitted to explora- lated RT (IMRT) is the most efficient external beam RT tory laparotomy. During the surgical procedure, Total delivery technique nowadays. Using a high gradient of Abdominal Hysterectomy and Bilateral Salpingectomy radiation dose enables the treatment of the target volume and Oophorectomy (TAH/BSO) were performed. The Page 1 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 pathological analysis revealed a mucinous cystic adenoma function, both by serum panel and isotopic nephrogram in her left ovary and an endometrioid cyst in her right evaluation. The nephrogram did not show any changes ovary (no evidence of malignancy). The endometrium compared to the initial exam. presented a solid, Serous Papiliferous Adenocarcinoma, poorly differentiated, compromising the inner half of the Discussion myometrium with extension to the upper endocervix. Patients with a pelvic kidney should not receive RT unless There was no lymph vascular space invasion and the mar- it is a mainstream in the treatment of that type of tumor. gins were not compromised. There are very few reports on treating pelvic kidneys She was classified as IIA by FIGO criteria [1] and received patients with EBRT [2-8]. 6 cycles of Carboplatin and Paclitaxel, followed by 29 Gy of High Dose Rate Brachytherapy (HDR BT) prescribed on It is important to establish the need, and the benefits of RT the vaginal surface, divided in 4 fractions, with median to any patient with in such a condition. dose to the rectum and bladder reference points of respec- Pelvic kidney function tively 48 and 58%. We used renal blood tests and isotopic nephrogram to She was referred to our Institution because she had a Con- access the patient's renal function. The scintigrafic study genital Pelvic Kidney. used static and dynamic assessment of glomerular and tubular function. Her right pelvic kidney took 45% of the Static and dynamic Scintigrafic renal function studies were radio labeled marker (DMSA/DTPA), and had normal performed. They showed that the pelvic kidney was func- excretion of it. Eighteen months after the treatment the tioning perfectly – it absorbed 45% of the injected radio- kidney' uptake was unchanged. active isotope. Scintigraphic renograms have correlated with biochemical A study plan for IMRT was led. It showed the dose to nor- and clearance end points [9], and are adequate for this sit- mal tissue and kidney was kept under tolerable limits. The uation, as the other kidney is functioning well, and any patient was informed of the risks and benefits of proceed- effect on the pelvic kidney would be better seen with func- ing with the treatment. The prescribed dose to cover 95% tional images rather than with functional biochemical of the target volume (whole pelvic drainage and vaginal exams. vault) was 45 Gy at 1.8 Gy per fraction. Benefit of adjuvant radiation and chemotherapy Seven co-planar fields were chosen at an interval rotation The standard surgical treatment for uterine neoplasia con- of 50 degrees. Dynamic Multileaf Collimation was used. sists of Radical Hysterectomy, bilateral salpingo The target volume excluded the entire pelvic kidney and oophorectomy, and lymphadenectomy or lymph node covered pelvic lymphatics from L5 down. sampling. RT field fluency is presented in figure 1, and Dose Distri- In this case, the surgical approach was not radical in intent bution is presented in figure 2. The dose volume analysis because the uterine neoplasia was an incidental finding. (DVH) is presented in figure 3. Therefore, the lymph node status was not known. In this setting, the benefit of re-operation is unclear and not evi- Planned dose distribution was verified dosimetrically and dence-based. The prospective PORTEC trial [10] has matched the software's calculation. The qualitative analy- directly tested the benefit of RT for patients without sis of isodose curves was satisfactory too. lymph node information. Patients with endometrial ade- nocarcinoma were randomized to receive postoperative During treatment, the patient presented peri-anal radio- pelvic EBRT, or no adjuvant therapy. They noticed a signif- dermitis (RTOG grade 1), increased bowel movements icant advantage in pelvic control for the adjuvant treat- (up to 3 times/day), and a lowering in platelet count lev- ment arm with risk features (deep myometrial invasion, els (75,000/mm3) which led to a 7 day treatment inter- cervical canal extension, high grade histology, or lymph ruption at 37.8 Gy. She subsequently recovered with a vascular space invasion), though not translated into sur- platelet rise to 90,000/mm3 and the treatment was vival benefit. The majority of failures occurred at the vag- resumed. The renal function panel was unaltered during inal vault. This study did not evaluate specifically serous the whole RT course. papiliferous tumors, but this subset of tumors is known to have a worse prognosis. This patient is classified as having When last seen – 18 months after the end of RT – the a high risk tumor. It is considered a non- endometrioid patient was free from disease. She had normal kidney tumor, not responsive to estrogenic castration. Metha and Page 2 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 Ra Figure 1 diation fluence Radiation fluence. shows radiation fields, their fluence maps, and the resulting dose distribution on a section plane that includes the pelvic kidney. cols [11] have studied a group of women with stage I-II Expected risks, side effects, and tolerance serous papiliferous tumors treated with surgery followed Kidney tolerance to radiation dose highly depends on the or not by adjuvant therapy. Though no variables were sta- irradiated volume. tistically correlated to prognosis, out of 13 women who did not receive RT/BT, 5 recurred in the pelvis (4 in the Tolerance dose for a 5% chance of late adverse effect at 5 vagina, 1 in the lateral pelvis). In contrast, none of the years is estimated to be 50 Gy for one third of the kidney, patients who received RT/BT (total of 10) recurred in the 30 Gy for two thirds, and 23 Gy for the whole kidney [12]. pelvis. The 5-year pelvic recurrence free survival was 100 It increases to 50% late toxicity if two thirds are irradiated vs. 57%, with a p = 0.06. to a dose of 40 Gy or one third to a dose of 28 Gy. This information and other published results suggesting a As noted on the DVH (figure 3) these parameters have benefit of carboplatin/paclitaxel based chemotherapy for been respected in the present case. this histological type and the fact that this histological type of tumor carries a high risk of recurrence makes us The literature does not define the optimal treatment for believe that our patient did benefit from the adjuvant patients with pelvic kidneys who need to undergo pelvic chemo-radiotherapy, including vaginal vault BT. RT. We could find 7 case reports concerning this subject Page 3 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 Dose distribution Figure 2 Dose distribution. shows the dose distribution for the 45 Gy prescribed dose. [2,4-8]. In 5 cases the primary tumor being treated was a RT fields, and properly match the dose distribution to the uterine cervix carcinoma [2,6-8]. In 3 of them, the kidney CT visible tumor, while evaluating dose received by nor- was transplanted outside the pelvis, away from the RT tar- mal tissue, therefore predicting treatment tolerance. It is get volume [2,7,8]. However, there was significant mor- however limited in achieving these goals when the tumor bidity related to the procedure, especially regarding the is surrounded by normal tissues with low radiation resist- graft vasculature, and the urinary tract. In one case an ade- ance, or when the normal organ is in the middle of the RT nocarcinoma of the uterine cervix in a transplanted port. In this setting IMRT has been shown effective, and its patient was treated initially with Intracavitary BT (low use for head and neck, thoracic, and abdominal treat- dose rate) followed by a modified field pelvic RT protect- ments have been increasing. ing the kidney, but partially compromising the RT target volume [6]. This patient relapsed on the border of the RT We showed that IMRT is also a good alternative in such a field. complex situation. It has prevented the patient from undergoing an auto-transplantation procedure. Other reports of auto-transplantation followed by RT for inguinal-pelvic irradiation in a vulvar cancer patient, and During treatment, this patient presented mild (common for adjuvant treatment of a stage III operated rectal aden- toxicity criteria grade 1) platelet complication. Lately ocarcinoma exists [4,5]. there has been an increase in the use of IMRT to spare the blood marrow, providing that, in case of a relapse and Although the preferred approach has not been estab- need for new chemotherapy regimens, maintaining as lished, no report exists on the use of high technology RT much functioning marrow as possible presents another in an attempt to accomplish an adequate plan without advantage of using IMRT. Roeske and cols have shown the moving the kidney out of the RT field. Conformal 3D RT main location of blood elements production in the pelvis has been developed to precisely study the combination of Page 4 of 5 (page number not for citation purposes) Radiation Oncology 2006, 1:44 http://www.ro-journal.com/content/1/1/44 D Figure 3 ose Volume Histogram Dose Volume Histogram. shows the graphic of Dose Volume Histogram. The curves show the distribution for the PTV, rectum, bladder, intestines, pelvic kidney and left topic kidney. 5. DeRoover A, Verni MP, Taylor RJ: Renal allograft autotransplan- [13], and it is possible to define these points as dose tation before pelvic irradiation. Transplantation 2000, restriction points for the IMRT planning. 70:844-846. 6. Ripley D, Levenback C, Eifel P, Lewis RM: Adenocarcinoma of the cervix in a renal transplant patient. Gynecol Oncol 1995, To our knowledge, this is the first report on the use of 59:151-155. IMRT to spare a pelvic kidney without compromising a 7. Rosenshein NB, Lichter AS, Walsh PC: Cervical cancer compli- cated by a pelvic kidney. J Urol 1980, 123:766-767. pelvic RT plan. 8. Roth TM, Woodring CT, McGehee RP: Stage II-B carcinoma of the cervix complicated by bilateral pelvic kidneys. Gynecol IMRT was a valid radiation technique to keep the pelvic Oncol 2004, 92:376-379. 9. Dewit L, Anninga JK, Hoefnagel CA, Nooijen WJ: Radiation injury kidney dose under acceptable dose volume constraints in the human kidney: a prospective analysis using specific without compromising the target volume. scintigraphic and biochemical endpoints. Int J Radiat Oncol Biol Phys 1990, 19:977-983. 10. Scholten AN, van Putten WL, Beerman H, Smit VT, Koper PC, IMRT should be considered an option for treating pelvic Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, De Winter KA, Lut- fields in patients who present a pelvic kidney. gens LC, van Lent M, Creutzberg CL: Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology References review. Int J Radiat Oncol Biol Phys 2005, 63:834-838. 1. Benedet JL, Bender H, Jones H III, Ngan HY, Pecorelli S: FIGO stag- 11. Mehta N, Yamada SD, Rotmensch J, Mundt AJ: Outcome and pat- ing classifications and clinical practice guidelines in the man- tern of failure in pathologic stage I-II papillary serous carci- agement of gynecologic cancers. FIGO Committee on noma of the endometrium: implications for adjuvant Gynecologic Oncology. Int J Gynaecol Obstet 2000, 70:209-262. radiation therapy. Int J Radiat Oncol Biol Phys 2003, 57:1004-1009. 2. Abouna GM, Micaily B, Lee DJ, Kumar MS, Jahshan AE, Lyons P: Sal- 12. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank vage of a kidney graft in a patient with advanced carcinoma B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeu- of the cervix by reimplantation of the graft from the pelvis tic irradiation. Int J Radiat Oncol Biol Phys 1991, 21:109-122. to the upper abdomen in preparation for radiation therapy. 13. Roeske JC, Lujan A, Reba RC, Penney BC, Diane YS, Mundt AJ: Incor- Transplantation 1994, 58:520-522. poration of SPECT bone marrow imaging into intensity 3. Bakri YN, Mansi M, Sundin T: Stage IIB carcinoma of the cervix modulated whole-pelvic radiation therapy treatment plan- complicated by an ectopic pelvic kidney. Int J Gynaecol Obstet ning for gynecologic malignancies. Radiother Oncol 2005, 1993, 42:174-176. 77:11-17. 4. Bokhari MB, Hostetter RB, Auber ML, Ulewicz DE: Locally advanced rectal cancer with a pelvic kidney complicating adjuvant radiation therapy. J Surg Oncol 1996, 63:57-60. Page 5 of 5 (page number not for citation purposes)

Journal

Radiation Oncology – Springer Journals

Published: Nov 20, 2006

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