• Reproducibility of radiation technique [ Designated as safety issue: No ]
  
• Bowel adverse events occurring within 90 days of study treatment [ Designated as safety issue: Yes ]
  
• Local-regional failure [ Designated as safety issue: No ]
  
• Distant metastases [ Designated as safety issue: No ]
  
• Disease-free survival [ Designated as safety issue: No ]
  
• Overall survival [ Designated as safety issue: No ]
  

OBJECTIVES:

• Determine the transportability of intensity modulated radiotherapy (IMRT) to a multi-institutional setting in patients with resected endometrial or cervical cancer.
• Compare the efficacy, in terms of reducing short-term bowel injury, of IMRT versus standard treatments.
• Assess adverse events related to this regimen.
• Estimate the rates of local-regional control, distant metastasis, and disease-free and overall survival.
• Evaluate chemotherapy compliance with this regimen for patients with cervical carcinoma.

OUTLINE: This is a multicenter study. Patients are stratified according to diagnosis (cervical vs endometrial cancer).

All patients undergo intensity modulated radiotherapy once a day, 5 days a week, for 5.5 weeks. Patients with cervical cancer also receive cisplatin IV over 30-60 minutes on day 1 or 2. Treatment with cisplatin repeats every 7 days for 5 courses (during radiotherapy) in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 3-5 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 92 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically confirmed diagnosis of 1 of the following:

  • Endometrial cancer meeting 1 of the following criteria:

    • Stage IB grade 3, IC grade 1-3, IIA, or IIB disease requiring postoperative pelvic radiotherapy
    • Unstaged (no lymph node dissection or sampling) stage IB grade 2 disease

    • Stage IIIC with all of the following:

      • Pelvic lymph node positive only
      • Para-aortic nodes sampled negative
      • Not receiving chemotherapy

  • Cervical cancer meeting 1 of the following criteria:

    • Post-radical hysterectomy and requires postoperative pelvic radiotherapy due to any of the following:

      • Positive pelvic nodes (negative para-aortic nodes)
      • Microscopic parametrial involvement
      • Close margins (≥ 3 mm)

      • Disease qualified by Sedlis criteria must have 2 of the following risk factors:

        • 1/3 or more stromal invasion
        • Lymph-vascular space invasion
        • Large clinical tumor diameter (≥ 4 cm)
    • Post-simple hysterectomy with negative margins (> 1 cm all around) and negative nodes by CT scan, MRI, or positron emission tomography-CT scan
• No requirement for extended-field radiotherapy beyond the pelvis
• No histologically confirmed papillary serous, clear cell, or neuroendocrine (either large or small cell) disease
• No evidence of metastatic disease outside of the pelvis
• No microscopic involvement of the resection margin (< 3 mm)

• Must have undergone a hysterectomy (total abdominal, vaginal, radical, or laparoscopic-assisted vaginal) in the past 7 weeks

  • Patients with endometrial cancer must have also undergone a bilateral salpingo-oophorectomy

PATIENT CHARACTERISTICS:

• Zubrod performance status 0-2
• WBC ≥ 4,000/mm³
• Absolute neutrophil count ≥ 1,800/mm³
• Platelet count ≥ 100,000/mm³
• Hemoglobin ≥ 8.0 g/dL (transfusion allowed)
• Creatinine ≤ 2.0 mg/dL
• Creatinine clearance ≥ 50 mL/min
• AST and ALT ≤ 2 times upper limit of normal
• Patients must not exceed the weight and size limits of the treatment table or CT scanner
• No mental status changes or bladder control problems that would preclude study compliance

• No severe, active, concurrent illness, including any of the following:

  • Active inflammatory bowel disease
  • Unstable angina
  • Congestive heart failure requiring hospitalization within the past 6 months
  • Transmural myocardial infarction within the past 6 months
  • Acute bacterial or fungal infection requiring IV antibiotics
  • Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy
  • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
  • AIDS
• No history of allergy to cisplatin (cervical cancer patients)
• No prior invasive malignancy (except nonmelanoma skin cancer) unless disease-free for ≥ 3 years (e.g., carcinoma in situ of the breast, oral cavity, or cervix)

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics

• No prior radiotherapy to the pelvis that would result in overlap of radiotherapy fields

  • Prior radiotherapy for breast cancer is allowed
• No prior platinum-based chemotherapy (cervical cancer patients)
• No concurrent prophylactic growth factors (e.g., filgrastim [G-CSF], sargramostim [GM-CSF], or pegfilgrastim)
• No concurrent prophylactic thrombopoietic agents
• No concurrent amifostine or other protective agents