Radiation-related toxicities and outcomes in endometrial cancer: are obese women at a disadvantage?
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To assess the impact of body mass index (BMI) on radiotherapy toxicities in endometrial cancer patients.
This was a retrospective cohort study of women diagnosed with endometrial cancer between January 2006 and December 2014 at the Royal Cornwall Hospital Trust. Women who received radiotherapy as part of their treatment, including external beam radiotherapy (EBRT) and/or vaginal brachytherapy were included. Radiation-related toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) guidelines. Toxicity outcomes were compared across BMI groups—non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2)—according to radiotherapy treatment received (EBRT, brachytherapy or a combination).
Of a total of 159 women who received radiotherapy, 110 were eligible for inclusion in the study. Sixty-three women had a BMI <30 kg/m2 and 47 women were obese. Obese women had poorer Eastern Cooperative Oncology Group performance status (P = 0.021) and more comorbidities (P < 0.001) compared to the non-obese group. Total (any) toxicity rates were 60.3, 72.7 and 52.0% for EBRT and brachytherapy (N = 63), single-mode EBRT (N = 22) and brachytherapy (N = 25), respectively. BMI was not associated with the incidence of acute and late radiation toxicities in the different radiotherapy groups, and there were no differences in individual complications between the BMI groups.
When comparing obese to non-obese women, obesity does not negatively impact the incidence of radiation toxicities in endometrial cancer. However, toxicities remain an important challenge as they are common and negatively influence the quality of life (QoL) of survivors. Future studies need to further explore the role of BMI and possible interventions to improve toxicities and QoL.
KeywordsObesity Radiation Toxicity Endometrial cancer
The authors are very grateful to the radiotherapy planning team at the Royal Cornwall Hospital Trust including Elaine Buck, Marina Cousins, Claire Cartledge and Tom Durnall for their contribution to the data collection. In addition, we would like to thank Frederique Bouwman for her contribution to data collection.
Compliance with ethical standards
Conflict of interest statement
(1) I declare that the contents of this paper have not been published or considered for publication elsewhere. (2) All authors made a substantial contribution to conception and design, and/or acquisition of data and/or analysis and interpretation of data; participated in drafting the article or revising it critically for important intellectual content; and gave final approval of the version to be submitted and any revised version to be published. (3) There is no financial support or relationship that may pose conflict of interest.
- 1.Cancer Research UK (2014) Uterine cancer incidence statistics. Cancer Research UK, London, UKGoogle Scholar
- 4.Creutzberg CL, van Putten WL, Koper PC et al (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post operative radiation therapy in endometrial carcinoma. Lancet 355(9213):1404–1411 (Epub 2000/05/03) CrossRefPubMedGoogle Scholar
- 6.Blake P, Swart AM, Astec En Study Group et al (2009) Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet 373(9658):137–146 (Epub 2008/12/17) CrossRefPubMedGoogle Scholar
- 8.Sorbe BG, Horvath G, Andersson H et al (2012) External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma: a prospective, randomized study–quality-of-life analysis. Int J Gynecol Cancer 22(7):1281–1288 (Epub 2012/08/07) CrossRefPubMedGoogle Scholar
- 15.IBM Corp (2012) IBM SPSS statistics for windows, version 21.0. IBM Corp, Armonk (Released) Google Scholar
- 18.Asiri MA, Tunio MA, Alhaddab AR et al (2012) Impact of body mass index on treatment outcomes of adjuvant radiation therapy in saudi females with endometrial carcinoma. World J Surg Med Radiat Oncol 1:119–129Google Scholar
- 20.Moszyńska-Zielińska M, Chałubińska-Fendler J, Gottwald L et al (2014) Does obesity hinder radiotherapy in endometrial cancer patients? The implementation of new techniques in adjuvant radiotherapy − focus on obese patients. Prz Menopauzalny 18(2):96–100 (Epub 2014 May 21) Google Scholar
- 25.Wong JR, Gao Z, Merrick S et al (2009) Potential for higher treatment failure in obese patients: correlation of elevated body mass index and increased daily prostate deviations from the radiation beam isocenters in an analysis of 1465 computed tomographic images. Int J Radiat Oncol Biol Phys 75(1):49–55 (Epub 2008/12/17) CrossRefPubMedGoogle Scholar
- 29.Mazeron R, Petit C, Rivin E et al (2015) 45 or 50 Gy, which is the optimal radiotherapy pelvic dose in locally advanced cervical cancer in the perspective of reaching magnetic resonance image-guided adaptive brachytherapy planning aims. Clin Oncol (R Coll Radiol) 28(3):171–177 (Epub 2015/11/09) CrossRefGoogle Scholar