Reddy E

Purpose: SABR has become the standard of care for inoperable early stage non-small cell lung cancer. Many patients are unable to safely receive a biopsy given poor pulmonary function with underlying emphysema and thus are empirically treated with radiotherapy. This study was performed to evaluate the efficacy and safety of definitive SABR in this population.

Methods: 69 patients were analyzed with a median follow up of 18 months. Patient, tumor, radiation doses, pulmonary function tests (including subgroups with FEV1 < 1.0 L, FEV1 < 1.5 L, FEV1 < 30%, and FEV1 < 35%) and toxicity (acute ≤ 90 days and late > 90 days) were analyzed to find associations between overall survival (OS) on Kaplan-Meier log-rank testing and differences in the patient populations with Chi- Square and Mann-Whitney U tests.

Results: The median age was 71. Sixty two tumors were peripheral (88.6%). There were 4 local recurrences (5.7%), 10 regional (different lobe and nodal) failures (14.29%), 15 distant metastases (21.4%) and a median survival of 17 months. There were differences in OS based on operability status (P=0.031), acute toxicity (P=0.000), and acute grade 2 toxicity (P=0.003). Significant factors for differences in distribution among patients with and without acute toxicity were O2 dependence (P=0.047), long term toxicity (P=0.000), and long term grade 2 toxicity (P=0.000). In the acute grade 2 toxicity analysis, O2 dependence (P=0.003), central vs peripheral location (P=0.000), new O2 requirement (P=0.022), long term toxicity (P=0.004), and long term grade 2 toxicity P=0.010) were significant. There were no significant differences based on pulmonary function testing (FEV1, FVC, or DLCO) or the analyzed PFT subgroups.

Conclusion: Operability and acute toxicity are associated with differences in OS in those patients undergoing empiric SABR. O2 dependence prior to treatment and not PFT parameters were associated with acute toxicities.

Purpose: SABR has become the standard of care for inoperable early stage non-small cell lung cancer. Many patients are unable to safely receive a biopsy given poor pulmonary function with underlying emphysema and thus are empirically treated with radiotherapy. This study was performed to evaluate the efficacy and safety of definitive SABR in this population.

Methods: 69 patients were analyzed with a median follow up of 18 months. Patient, tumor, radiation doses, pulmonary function tests (including subgroups with FEV1 < 1.0 L, FEV1 < 1.5 L, FEV1 < 30%, and FEV1 < 35%) and toxicity (acute ≤ 90 days and late > 90 days) were analyzed to find associations between overall survival (OS) on Kaplan-Meier log-rank testing and differences in the patient populations with Chi- Square and Mann-Whitney U tests.

Results: The median age was 71. Sixty two tumors were peripheral (88.6%). There were 4 local recurrences (5.7%), 10 regional (different lobe and nodal) failures (14.29%), 15 distant metastases (21.4%) and a median survival of 17 months. There were differences in OS based on operability status (P=0.031), acute toxicity (P=0.000), and acute grade 2 toxicity (P=0.003). Significant factors for differences in distribution among patients with and without acute toxicity were O2 dependence (P=0.047), long term toxicity (P=0.000), and long term grade 2 toxicity (P=0.000). In the acute grade 2 toxicity analysis, O2 dependence (P=0.003), central vs peripheral location (P=0.000), new O2 requirement (P=0.022), long term toxicity (P=0.004), and long term grade 2 toxicity P=0.010) were significant. There were no significant differences based on pulmonary function testing (FEV1, FVC, or DLCO) or the analyzed PFT subgroups.

Conclusion: Operability and acute toxicity are associated with differences in OS in those patients undergoing empiric SABR. O2 dependence prior to treatment and not PFT parameters were associated with acute toxicities.

Purpose: SABR has become the standard of care for inoperable early stage non-small cell lung cancer. Many patients are unable to safely receive a biopsy given poor pulmonary function with underlying emphysema and thus are empirically treated with radiotherapy. This study was performed to evaluate the efficacy and safety of definitive SABR in this population.

Methods: 69 patients were analyzed with a median follow up of 18 months. Patient, tumor, radiation doses, pulmonary function tests (including subgroups with FEV1 < 1.0 L, FEV1 < 1.5 L, FEV1 < 30%, and FEV1 < 35%) and toxicity (acute ≤ 90 days and late > 90 days) were analyzed to find associations between overall survival (OS) on Kaplan-Meier log-rank testing and differences in the patient populations with Chi- Square and Mann-Whitney U tests.

Results: The median age was 71. Sixty two tumors were peripheral (88.6%). There were 4 local recurrences (5.7%), 10 regional (different lobe and nodal) failures (14.29%), 15 distant metastases (21.4%) and a median survival of 17 months. There were differences in OS based on operability status (P=0.031), acute toxicity (P=0.000), and acute grade 2 toxicity (P=0.003). Significant factors for differences in distribution among patients with and without acute toxicity were O2 dependence (P=0.047), long term toxicity (P=0.000), and long term grade 2 toxicity (P=0.000). In the acute grade 2 toxicity analysis, O2 dependence (P=0.003), central vs peripheral location (P=0.000), new O2 requirement (P=0.022), long term toxicity (P=0.004), and long term grade 2 toxicity P=0.010) were significant. There were no significant differences based on pulmonary function testing (FEV1, FVC, or DLCO) or the analyzed PFT subgroups.

Conclusion: Operability and acute toxicity are associated with differences in OS in those patients undergoing empiric SABR. O2 dependence prior to treatment and not PFT parameters were associated with acute toxicities.

Purpose: To inform stakeholders of a newly formed, VAbased, research oriented collaborative group, the Veterans Radiation Oncology Consortium (VET-ROC).

Background: To strengthen, promote and enhance VA oncology and radiation oncology centered research, VET-ROC was conceived in October 2018 at the San Antonio VA Radiation Oncology Field Based Meeting and formed with the consent of 18 members sites.

Results: An email sent to all 85 known VA radiation oncologists in October 2018 drew 18 positive responses to join a clinical research consortium within VA. Members responded to 2 questionnaires about the state of their program in October 2018 and April 2019. Per their responses, VET-ROC sites consist of approximately 47 FTE Radiation Oncologists and > 26 FTE Physicists. The sites reported a total of 7.1 FTEE Clinical Research Coordinators (CRC’s) in October 2018 and 10.2 FTE CRC’s in April 2019 with most sites sharing CRC’s with other specialties. Five sites reported a lack of any research coordinator in October 2018, and in April 2019, 3 of those 5 sites had received approval from their resource management committees to hire CRCs.

The group had a face to face meeting in FEB 2019 and has held conference calls every 4-6 weeks since then to review opportunities for research, shared best practices, partake in educational webinars, identify barriers to research development, opportunities for research proposals with at least 2 groups of members submitting Merit Review awards to CSR&D that may have been possible as a result of VET-ROC. Feedback on the progress the group has made has been largely positive. Individual responses noted that the group had created opportunities that would not have been possible otherwise. There were suggestions to formalize the structure of the group.

Conclusion: Since its formation, VET-ROC has been a very positive experience for its members who consist of a select group of Radiation Oncologists with shared common interests in clinical research. The group will likely continue to move grow and move forward if it can translate its momentum into research support obtained from a diverse source of funding mechanisms.

Purpose: To inform stakeholders of a newly formed, VAbased, research oriented collaborative group, the Veterans Radiation Oncology Consortium (VET-ROC).

Background: To strengthen, promote and enhance VA oncology and radiation oncology centered research, VET-ROC was conceived in October 2018 at the San Antonio VA Radiation Oncology Field Based Meeting and formed with the consent of 18 members sites.

Results: An email sent to all 85 known VA radiation oncologists in October 2018 drew 18 positive responses to join a clinical research consortium within VA. Members responded to 2 questionnaires about the state of their program in October 2018 and April 2019. Per their responses, VET-ROC sites consist of approximately 47 FTE Radiation Oncologists and > 26 FTE Physicists. The sites reported a total of 7.1 FTEE Clinical Research Coordinators (CRC’s) in October 2018 and 10.2 FTE CRC’s in April 2019 with most sites sharing CRC’s with other specialties. Five sites reported a lack of any research coordinator in October 2018, and in April 2019, 3 of those 5 sites had received approval from their resource management committees to hire CRCs.

The group had a face to face meeting in FEB 2019 and has held conference calls every 4-6 weeks since then to review opportunities for research, shared best practices, partake in educational webinars, identify barriers to research development, opportunities for research proposals with at least 2 groups of members submitting Merit Review awards to CSR&D that may have been possible as a result of VET-ROC. Feedback on the progress the group has made has been largely positive. Individual responses noted that the group had created opportunities that would not have been possible otherwise. There were suggestions to formalize the structure of the group.

Conclusion: Since its formation, VET-ROC has been a very positive experience for its members who consist of a select group of Radiation Oncologists with shared common interests in clinical research. The group will likely continue to move grow and move forward if it can translate its momentum into research support obtained from a diverse source of funding mechanisms.

Purpose: To inform stakeholders of a newly formed, VAbased, research oriented collaborative group, the Veterans Radiation Oncology Consortium (VET-ROC).

Background: To strengthen, promote and enhance VA oncology and radiation oncology centered research, VET-ROC was conceived in October 2018 at the San Antonio VA Radiation Oncology Field Based Meeting and formed with the consent of 18 members sites.

Results: An email sent to all 85 known VA radiation oncologists in October 2018 drew 18 positive responses to join a clinical research consortium within VA. Members responded to 2 questionnaires about the state of their program in October 2018 and April 2019. Per their responses, VET-ROC sites consist of approximately 47 FTE Radiation Oncologists and > 26 FTE Physicists. The sites reported a total of 7.1 FTEE Clinical Research Coordinators (CRC’s) in October 2018 and 10.2 FTE CRC’s in April 2019 with most sites sharing CRC’s with other specialties. Five sites reported a lack of any research coordinator in October 2018, and in April 2019, 3 of those 5 sites had received approval from their resource management committees to hire CRCs.

The group had a face to face meeting in FEB 2019 and has held conference calls every 4-6 weeks since then to review opportunities for research, shared best practices, partake in educational webinars, identify barriers to research development, opportunities for research proposals with at least 2 groups of members submitting Merit Review awards to CSR&D that may have been possible as a result of VET-ROC. Feedback on the progress the group has made has been largely positive. Individual responses noted that the group had created opportunities that would not have been possible otherwise. There were suggestions to formalize the structure of the group.

Conclusion: Since its formation, VET-ROC has been a very positive experience for its members who consist of a select group of Radiation Oncologists with shared common interests in clinical research. The group will likely continue to move grow and move forward if it can translate its momentum into research support obtained from a diverse source of funding mechanisms.

Purpose: It is conventional to treat pelvic lymph nodes, followed by prostate boost in a sequential manner, requiring 8-9 weeks to complete therapy. In the last several years there have been several randomized studies of implementing moderate hypofractionated radiotherapy in prostate cancer to shorten the treatment time, which has proven to be non-inferior to conventional treatment. The purpose of this retrospective study is to evaluate the acute toxicities of hypofractionated SIB radiotherapy in treating the lymph nodes with prostate boost.

Methods: Between 2015 and 2017, twenty five high risk prostate cancer patients received pelvic node radiotherapy with prostate boost in 25 fractions with SIB technique with neo-adjuvant and concurrent hormone therapy to 50 Gy/25 fractions at 2 Gy/fraction to pelvic nodes and prostate boost for a total of 67.5 - 75 Gy at 2.7 to 3.0 Gy/fraction. We followed QUNTAC dose-volume constraints for the rectum, bladder and bowel. All these patients received long-term hormone therapy.

Results: The median age was 66 years (range 57-81 years). There were 6 stage II C, 7 III A, 15 III C, and 1 stage IV A. All patients were restaged as per American Joint Committee on Cancer 8th edition. Gleason Score: 6 (1), 7 (4+3) (4), 8 (5), and 9-10 (15). The average PSA was 17.2 ng/mL with a range of 5.6 to 51.92 ng/mL, and average number of positive cores was 74%. These factors put the majority of patients into the very high risk group. The median follow up was 24 months. The majority of the patients tolerated treatment well. Grade 0 genitourinary (GU) toxicity occurred
in 8 (33%) patients, grade II 16 (67%) patients, one patient had a Foley catheter during treatment, a majority of patients were on alpha blockers either before, during or post radiotherapy. Grade 0 gastrointestinal (GI) toxicity occurred in 21 (84%) patients, grade 1 in one, and grade II in 3 (12%) patients. There were no grade 3 or 4 GU or GI toxicities.

Conclusions: Simultaneous integrated boost with VMAT is well tolerated in treating pelvic nodes and prostate boost, without any major acute toxicities. This technique is used in mostly for very high risk localized prostate cancer patients, reducing number of fractions from conventional sequential treatment.

Purpose: It is conventional to treat pelvic lymph nodes, followed by prostate boost in a sequential manner, requiring 8-9 weeks to complete therapy. In the last several years there have been several randomized studies of implementing moderate hypofractionated radiotherapy in prostate cancer to shorten the treatment time, which has proven to be non-inferior to conventional treatment. The purpose of this retrospective study is to evaluate the acute toxicities of hypofractionated SIB radiotherapy in treating the lymph nodes with prostate boost.

Methods: Between 2015 and 2017, twenty five high risk prostate cancer patients received pelvic node radiotherapy with prostate boost in 25 fractions with SIB technique with neo-adjuvant and concurrent hormone therapy to 50 Gy/25 fractions at 2 Gy/fraction to pelvic nodes and prostate boost for a total of 67.5 - 75 Gy at 2.7 to 3.0 Gy/fraction. We followed QUNTAC dose-volume constraints for the rectum, bladder and bowel. All these patients received long-term hormone therapy.

Results: The median age was 66 years (range 57-81 years). There were 6 stage II C, 7 III A, 15 III C, and 1 stage IV A. All patients were restaged as per American Joint Committee on Cancer 8th edition. Gleason Score: 6 (1), 7 (4+3) (4), 8 (5), and 9-10 (15). The average PSA was 17.2 ng/mL with a range of 5.6 to 51.92 ng/mL, and average number of positive cores was 74%. These factors put the majority of patients into the very high risk group. The median follow up was 24 months. The majority of the patients tolerated treatment well. Grade 0 genitourinary (GU) toxicity occurred
in 8 (33%) patients, grade II 16 (67%) patients, one patient had a Foley catheter during treatment, a majority of patients were on alpha blockers either before, during or post radiotherapy. Grade 0 gastrointestinal (GI) toxicity occurred in 21 (84%) patients, grade 1 in one, and grade II in 3 (12%) patients. There were no grade 3 or 4 GU or GI toxicities.

Conclusions: Simultaneous integrated boost with VMAT is well tolerated in treating pelvic nodes and prostate boost, without any major acute toxicities. This technique is used in mostly for very high risk localized prostate cancer patients, reducing number of fractions from conventional sequential treatment.

Purpose: It is conventional to treat pelvic lymph nodes, followed by prostate boost in a sequential manner, requiring 8-9 weeks to complete therapy. In the last several years there have been several randomized studies of implementing moderate hypofractionated radiotherapy in prostate cancer to shorten the treatment time, which has proven to be non-inferior to conventional treatment. The purpose of this retrospective study is to evaluate the acute toxicities of hypofractionated SIB radiotherapy in treating the lymph nodes with prostate boost.

Methods: Between 2015 and 2017, twenty five high risk prostate cancer patients received pelvic node radiotherapy with prostate boost in 25 fractions with SIB technique with neo-adjuvant and concurrent hormone therapy to 50 Gy/25 fractions at 2 Gy/fraction to pelvic nodes and prostate boost for a total of 67.5 - 75 Gy at 2.7 to 3.0 Gy/fraction. We followed QUNTAC dose-volume constraints for the rectum, bladder and bowel. All these patients received long-term hormone therapy.

Results: The median age was 66 years (range 57-81 years). There were 6 stage II C, 7 III A, 15 III C, and 1 stage IV A. All patients were restaged as per American Joint Committee on Cancer 8th edition. Gleason Score: 6 (1), 7 (4+3) (4), 8 (5), and 9-10 (15). The average PSA was 17.2 ng/mL with a range of 5.6 to 51.92 ng/mL, and average number of positive cores was 74%. These factors put the majority of patients into the very high risk group. The median follow up was 24 months. The majority of the patients tolerated treatment well. Grade 0 genitourinary (GU) toxicity occurred
in 8 (33%) patients, grade II 16 (67%) patients, one patient had a Foley catheter during treatment, a majority of patients were on alpha blockers either before, during or post radiotherapy. Grade 0 gastrointestinal (GI) toxicity occurred in 21 (84%) patients, grade 1 in one, and grade II in 3 (12%) patients. There were no grade 3 or 4 GU or GI toxicities.

Conclusions: Simultaneous integrated boost with VMAT is well tolerated in treating pelvic nodes and prostate boost, without any major acute toxicities. This technique is used in mostly for very high risk localized prostate cancer patients, reducing number of fractions from conventional sequential treatment.

Purpose: In stereotactic body radiation therapy (SBRT) of lung tumors, to reduce the target motion and to minimize lung volume treated, the generally accepted procedure is to use abdominal compression, but sometimes abdominal compression is not enough to reduce target motion, particularly the lower lobe lesions.

Methods: When we didn’t have abdominal compression device in our department at the start of our SBRT program, to reduce the target motion, we did CT simulation of patients in both supine and prone position to see if there would be any reduction in the target motion. We planned
and treated four patients in a prone position taking the substantial reduction in target motion into consideration.

Results: It was observed that there was a significant reduction in the target motion ranging from 1.5 cm to 3.0 cm in prone position, the reduction in motion of target is seen mostly in middle and particularly lower lobe lesions, and there was not much change in target motion in upper lobe lesions.

Conclusions: Abdominal compression is both patient and operator oriented and could be uncomfortable to the patient depending on the pressure exerted with compression, whereas prone position is only patient oriented and self-adjusting and settling in a comfortable position prior to CT simulation and prior to initiation of treatment which is verified by image guided radiation therapy (cone based CT). It may not be practical in every patient but could be an option in some patients and particularly in for lower lobe lesions.

Purpose: In stereotactic body radiation therapy (SBRT) of lung tumors, to reduce the target motion and to minimize lung volume treated, the generally accepted procedure is to use abdominal compression, but sometimes abdominal compression is not enough to reduce target motion, particularly the lower lobe lesions.

Methods: When we didn’t have abdominal compression device in our department at the start of our SBRT program, to reduce the target motion, we did CT simulation of patients in both supine and prone position to see if there would be any reduction in the target motion. We planned
and treated four patients in a prone position taking the substantial reduction in target motion into consideration.

Results: It was observed that there was a significant reduction in the target motion ranging from 1.5 cm to 3.0 cm in prone position, the reduction in motion of target is seen mostly in middle and particularly lower lobe lesions, and there was not much change in target motion in upper lobe lesions.

Conclusions: Abdominal compression is both patient and operator oriented and could be uncomfortable to the patient depending on the pressure exerted with compression, whereas prone position is only patient oriented and self-adjusting and settling in a comfortable position prior to CT simulation and prior to initiation of treatment which is verified by image guided radiation therapy (cone based CT). It may not be practical in every patient but could be an option in some patients and particularly in for lower lobe lesions.

Purpose: In stereotactic body radiation therapy (SBRT) of lung tumors, to reduce the target motion and to minimize lung volume treated, the generally accepted procedure is to use abdominal compression, but sometimes abdominal compression is not enough to reduce target motion, particularly the lower lobe lesions.

Methods: When we didn’t have abdominal compression device in our department at the start of our SBRT program, to reduce the target motion, we did CT simulation of patients in both supine and prone position to see if there would be any reduction in the target motion. We planned
and treated four patients in a prone position taking the substantial reduction in target motion into consideration.

Results: It was observed that there was a significant reduction in the target motion ranging from 1.5 cm to 3.0 cm in prone position, the reduction in motion of target is seen mostly in middle and particularly lower lobe lesions, and there was not much change in target motion in upper lobe lesions.

Conclusions: Abdominal compression is both patient and operator oriented and could be uncomfortable to the patient depending on the pressure exerted with compression, whereas prone position is only patient oriented and self-adjusting and settling in a comfortable position prior to CT simulation and prior to initiation of treatment which is verified by image guided radiation therapy (cone based CT). It may not be practical in every patient but could be an option in some patients and particularly in for lower lobe lesions.

Purpose: The optimal adjuvant radiotherapy for uterine cancer remains controversial. For intermediate-risk or high-risk uterine cancer, generally accepted adjuvant radiation is either vaginal brachytherapy (VBT) or external beam radiotherapy (EBRT) or combination of EBRT followed by VBT boost to vaginal cuff. Because many VA medical centers are not equipped with brachytherapy service to accomplish this task, the patients are referred for non-VA care to other institutions for VBT. At Kansas City VA Medical Center (KCVAMC), we looked at the feasibility of simultaneous integrated boost (SIB) to vaginal cuff with intensity-modulated radiation therapy (IMRT) in lieu of VBT.

Methods: Two patients with uterine malignancies were seen at KCVAMC after total abdominal hysterectomy and bilateral salpingo oophorectomy, referred for adjuvant radiotherapy: Patient 1 is a 69-year-old woman with grade 2 adenocarcinoma with > 50% myometrial invasion; Patient 2 is a 63-year-old woman with undifferentiated uterine sarcoma with microscopic involvement of lymph nodes with non-Hodgkin lymphoma, completed 3 cycles of R-CHOP chemotherapy and referred for adjuvant radiotherapy. Both patients were planned for whole pelvic radiation with planning CT simulation with vaginal cylinder for delineating the target boost volume, which is about upper half of the vagina with 1.0 to 1.5 cm superior and lateral margins. An IMRT plan was generated to cover the whole pelvis and boost volume to deliver 51 to 54 Gy to whole pelvis with 60 Gy to boost volume in 30 fractions. A dose constraint to bladder and rectum was observed.

Results: In this case report a technique of SIB to vaginal cuff in lieu of VBT is described. This technique is feasible, convenient, and less expensive for patients who are recommended for VBT boost. Both patients developed grade 2 gastrointestinal toxicity with diarrhea, which was well controlled with symptomatic medication. Both patients are about 1 year from completion of treatment and doing well.

Purpose: The optimal adjuvant radiotherapy for uterine cancer remains controversial. For intermediate-risk or high-risk uterine cancer, generally accepted adjuvant radiation is either vaginal brachytherapy (VBT) or external beam radiotherapy (EBRT) or combination of EBRT followed by VBT boost to vaginal cuff. Because many VA medical centers are not equipped with brachytherapy service to accomplish this task, the patients are referred for non-VA care to other institutions for VBT. At Kansas City VA Medical Center (KCVAMC), we looked at the feasibility of simultaneous integrated boost (SIB) to vaginal cuff with intensity-modulated radiation therapy (IMRT) in lieu of VBT.

Methods: Two patients with uterine malignancies were seen at KCVAMC after total abdominal hysterectomy and bilateral salpingo oophorectomy, referred for adjuvant radiotherapy: Patient 1 is a 69-year-old woman with grade 2 adenocarcinoma with > 50% myometrial invasion; Patient 2 is a 63-year-old woman with undifferentiated uterine sarcoma with microscopic involvement of lymph nodes with non-Hodgkin lymphoma, completed 3 cycles of R-CHOP chemotherapy and referred for adjuvant radiotherapy. Both patients were planned for whole pelvic radiation with planning CT simulation with vaginal cylinder for delineating the target boost volume, which is about upper half of the vagina with 1.0 to 1.5 cm superior and lateral margins. An IMRT plan was generated to cover the whole pelvis and boost volume to deliver 51 to 54 Gy to whole pelvis with 60 Gy to boost volume in 30 fractions. A dose constraint to bladder and rectum was observed.

Results: In this case report a technique of SIB to vaginal cuff in lieu of VBT is described. This technique is feasible, convenient, and less expensive for patients who are recommended for VBT boost. Both patients developed grade 2 gastrointestinal toxicity with diarrhea, which was well controlled with symptomatic medication. Both patients are about 1 year from completion of treatment and doing well.

Purpose: The optimal adjuvant radiotherapy for uterine cancer remains controversial. For intermediate-risk or high-risk uterine cancer, generally accepted adjuvant radiation is either vaginal brachytherapy (VBT) or external beam radiotherapy (EBRT) or combination of EBRT followed by VBT boost to vaginal cuff. Because many VA medical centers are not equipped with brachytherapy service to accomplish this task, the patients are referred for non-VA care to other institutions for VBT. At Kansas City VA Medical Center (KCVAMC), we looked at the feasibility of simultaneous integrated boost (SIB) to vaginal cuff with intensity-modulated radiation therapy (IMRT) in lieu of VBT.

Methods: Two patients with uterine malignancies were seen at KCVAMC after total abdominal hysterectomy and bilateral salpingo oophorectomy, referred for adjuvant radiotherapy: Patient 1 is a 69-year-old woman with grade 2 adenocarcinoma with > 50% myometrial invasion; Patient 2 is a 63-year-old woman with undifferentiated uterine sarcoma with microscopic involvement of lymph nodes with non-Hodgkin lymphoma, completed 3 cycles of R-CHOP chemotherapy and referred for adjuvant radiotherapy. Both patients were planned for whole pelvic radiation with planning CT simulation with vaginal cylinder for delineating the target boost volume, which is about upper half of the vagina with 1.0 to 1.5 cm superior and lateral margins. An IMRT plan was generated to cover the whole pelvis and boost volume to deliver 51 to 54 Gy to whole pelvis with 60 Gy to boost volume in 30 fractions. A dose constraint to bladder and rectum was observed.

Results: In this case report a technique of SIB to vaginal cuff in lieu of VBT is described. This technique is feasible, convenient, and less expensive for patients who are recommended for VBT boost. Both patients developed grade 2 gastrointestinal toxicity with diarrhea, which was well controlled with symptomatic medication. Both patients are about 1 year from completion of treatment and doing well.