Radiation‐Associated Toxicities in Obese Women with Endometrial Cancer: More Than Just BMI?

Abstract

Purpose. The study characterizes the impact of obesity on postoperative radiation-associated toxicities in women with endometrial cancer (EC). Material and Methods. A retrospective study identified 96 women with EC referred to a large urban institution's radiation oncology practice for postoperative whole pelvic radiotherapy (WPRT) and/or intracavitary vaginal brachytherapy (ICBT). Demographic and clinicopathologic data were obtained. Toxicities were graded according to RTOG Acute Radiation Morbidity Scoring Criteria. Follow-up period ranged from 1 month to 11 years (median 2 years). Data were analyzed by χ 2, logistic regression, and recursive partitioning analyses. Results. 68 EC patients who received WPRT and/or ICBT were analyzed. Median age was 52 years (29–73). The majority were Hispanic (71%). Median BMI at diagnosis was 34.5 kg/m2 (20.5–56.6 kg/m2). BMI was independently associated with radiation-related cutaneous (p = 0.022) and gynecologic-related (p = 0.027) toxicities. Younger women also reported more gynecologic-related toxicities (p = 0.039). Adjuvant radiation technique was associated with increased gastrointestinal- and genitourinary-related toxicities but not gynecologic-related toxicity. Conclusions. Increasing BMI was associated with increased frequency of gynecologic and cutaneous radiation-associated toxicities. Additional studies to critically evaluate the radiation treatment dosing and treatment fields in obese EC patients are warranted to identify strategies to mitigate the radiation-associated toxicities in these women.

Acute chemoradiotherapy toxicity in cervical cancer patients

“…A study conducted by Smits et al shows that obesity and BMI over 30 kg/m 2 are not associated with higher grades of ART [ 40 ]. Similarly, another study show that obesity in young patients with endometrial cancer is not associated with the onset of genitourinary and gastrointestinal toxicities [ 41 ]. Lim et al have found that obesity reduces the rectal dose during HDR brachytherapy due to larger quantity of fat tissue in the recto-uterine space, but does not affect the occurrence of acute gastrointestinal toxicity [ 42 ].…”

Acute radiation toxicity during and after concurrent chemoradiotherapy in patients with localy advanced cervical cancer

“…An increased incidence of acute gynecological radiation toxicity in young and obese patients with cancer of genital organs was noted, while urinary and gastrointestinal toxicity were not associated with obesity 58 . On the contrary, Smits et al claim that obesity and a body mass index over 30 kg/m 2 are not associated with the larger of radiation toxicity 59 .…”

Is Host Metabolism the Missing Link to Improving Cancer Outcomes?

“…[32] In addition, overweight and obese men are more prone to developing late pelvic symptoms after radiotherapy for prostate cancer, including higher rates of rectal bleeding and nocturia [33]. Similarly, in women with endometrial cancer treated with radiation, mean BMI positively correlates with higher-grade radiation-related gynecologic and cutaneous toxicities [34]. An analysis of pulmonary tumors less than 2.5 cm from the chest wall treated with stereotactic body radiation therapy (SBRT) further found that BMI was the strongest predictor of chest wall pain after treatment, with patients whose BMI was ≥29 having nearly twice the risk of chronic chest wall pain than patients with lower BMI [35].…”