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Invited Commentary
April 14, 2022

Are We Finally Ready for the Widespread Adoption of Stereotactic Radiation in Gynecologic Cancers?

Author Affiliations
  • 1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Radiation Oncology, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
JAMA Oncol. 2022;8(6):861-862. doi:10.1001/jamaoncol.2022.0260

In this issue of JAMA Oncology, Leung et al1 present the first prospective phase 1/2 single-group trial, The Stereotactic Pevlic Adjuvant Radiation Therapy in Cancers of the Uterus (SPARTACUS), of accelerated hypofractionation/stereotactic body radiation therapy (SBRT) for postoperative pelvic radiation in patients with stage I to III uterine cancer. In total, 61 patients were accrued between May 2019 and August 2021 and received 30 Gy in 5 fractions, using either once a week (13 patients) or every other day (48 patients) treatment schedules. The primary end point was physician-reported acute gastrointestinal (GI) tract and genitourinary toxic effects. There are many potential benefits to a shorter radiation treatment schedule, as the authors discuss. The benefits include quicker time of completing systemic therapy in advanced uterine cancer, decreased financial challenges owing to travel, lost wages, and housing that may be needed to facilitate weeks of treatment, and decreased exposure to high-risk hospital settings during the height of the COVID-19 pandemic. The authors found at a median follow-up of 9 months (IQR, 3-15 months) that rates of acute GI tract toxic effects of grade 1 and 2 were 54% and 13%, respectively, and acute genitourinary toxic effects of grade 1 and 2 were 41% and 3%, respectively. Treatment with stereotactic radiation would have been deemed too toxic if more than 20% of patients had grade 3 or higher toxic effects.

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