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

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.IMRT is a valid technique to prevent the kidney from radiation damage.Randomized trials have shown that Pelvic Radiotherapy (RT) as a postoperative treatment for intermediate and high risk endometrial cancer improves local regional control. Its impact on overall survival is still unknown. Intra-cavitary Brachytherapy also improves vaginal control. Both treatments, however, imply significant side effects that a fine technique can help avoiding. Intensity Modulated RT (IMRT) is the most efficient external beam RT delivery technique nowadays. Using a high gradient of radiation dose enables the treatment of the target volume while protecting normal tissues in an attempt to reduce the incidence and severity of side effects.A 50-year old Caucasian woman was referred to the Radiation Oncology Department of Hospital do Cancer A C Camargo, S？o Paulo, Brazil, with Endometrial Cancer. Due to bilateral ovary mass she was submitted to exploratory laparotomy. During the surgical procedure, Total Abdominal Hysterectomy and Bilateral Salpingectomy and Oophorectomy (TAH/BSO) were performed. The pathological analysis revealed a mucinous cystic adenoma in her left ovary and an endometrioid cyst in her right ovary (no evidence of malignancy). The endometrium presented a solid, Serous Papiliferous Adenocarcinoma, poorly differentiated, compromising the inner half of the myometrium with extension to the upper endocervix. There was no lymph vascular space invasion and the margins were not compromised.She was classified as IIA by FIGO criteria [1] and received 6 cycles of Carboplatin and Paclitaxel, followed by 29 Gy of High Dose Rate Brachythe