Radiation Therapy Sandwiched Between Paclitaxel and Carboplatin in Patients With High-risk Endometrial Cancer

• To assess and document location of disease recurrence (distant vs. local. vs. both) using this treatment regimen. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
• To evaluate the toxicity of pelvic radiation "sandwiched" between cycles of paclitaxel/carboplatin chemotherapy in patients with high-risk endometrial cancer. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]

In this study, radiation is "sandwiched" between paclitaxel/carboplatin chemotherapy in attempts to decrease the chance of the cancer returning in the pelvis or elsewhere in the body. This study will evaluate the tolerability of combining radiation with chemotherapy in this way. We will also evaluate any side effects that patients may experience with this treatment.

• Before chemotherapy, patients will receive extra fluid by IV for 2 hours, and will be given medicine to prevent side effects from the chemotherapy drugs.
• Chemotherapy treatments will be given intravenously in the outpatient clinic. Patients will receive IV paclitaxel/carboplatin chemotherapy every 21 days for 3 cycles.
• After 3 cycles of chemotherapy, patients will receive external beam radiotherapy. Radiation will be delivered to the patient's pelvis at the dose prescribed by the Radiation Oncologist.
• External radiation will be given once a day, five days a week (Monday-Friday) for 5 weeks.
• Patients will then receive internal high-dose radiation, which will be given once a week for three weeks. This type of radiation is given through a vaginal cylinder, a device that is inserted in the vagina that directs the radiation to your tumor. It is a procedure that is done with anesthesia.
• The 4th cycle of chemotherapy will overlap with the high dose radiation.
• The remainder of the planned 6 cycles of paclitaxel/carboplatin therapy will continue to be administered every 21 days.
• Prior to and during the study, tests and procedures will be performed; including physical examinations, routine blood tests, urine tests, ECG, medical history and vital signs, radiologic examinations.
• The study treatment will proceed as long as the tumor does not grow and the patient isn't experiencing any severe side effects.

• Drug: Paclitaxel
  During weeks 1-9 and weeks 13-21, a diluted solution of Paclitaxel will be infused via a peripheral or central vein over three hours, every 21 days.
  Other Name: Taxol
• Drug: Carboplatin
  During weeks 1-9 and weeks 13-21, a diluted solution of Carboplatin will be infused via a peripheral or central vein, every 21 days.
  Other Name: Paraplatin
• Radiation: Pelvic and Para-Aortic Radiation 6MV Photon Beam Energy
  During weeks 8-12, patient will be given radiation once per day, five days a week, for five weeks.
• Radiation: High Dose Radiation
  During weeks 13-15, patient will be given high dose radiation via a vaginal cylinder, once per week for three weeks.

Inclusion Criteria:

• Histologically-documented high-risk endometrioid adenocarcinoma with no visible residual disease, defined by the following criteria:

  1. Surgical stage I disease with < 50 myometrial invasion and grade 3 tumor (IBG3) with lymphovascular space involvement;
  2. Surgical stage I disease with > 50% myometrial invasion and grade 2 or 3 tumor (ICG2, ICG3);
  3. Any surgical stage II disease (IIA, IIB);
  4. Any surgical stage III disease (IIIA, IIIB, IIIC); and
  5. Any surgical stage IV disease with no residual macroscopic tumor
• Surgical staging to include total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, and lymph node samplings as per standard GOG criteria.
• Age > 18 years.
• ECOG performance status of < 2.

Exclusion Criteria:

• Patient has impairment of hepatic, renal or hematologic function as defined by the following baseline laboratory values:

  1. Serum SGOT and /or SGPT > 2.5 times the institutional upper limit of normal
  2. Total serum bilirubin > 1.5 mg/dl
  3. History of chronic or active hepatitis
  4. Serum creatinine > 2.0 mg/dl
  5. Platelets < 100,000/mm3
  6. Absolute neutrophil count (ANC) < 1500/mm3
  7. Hemoglobin < 8.0 g/dl (the patient may be transfused prior to study entry).
• Patient has severe or uncontrolled concurrent medical disease (eg Un-controlled diabetes, unstable angina, myocardial infarction within 6 months, congestive heart failure, etc.)
• Patient with any prior chemotherapy or radiotherapy for pelvic malignancy.
• Patients with dementia or altered mental status that would prohibit the giving and understanding of informed consent at the time of study entry.
• Patients with any history of cancer with the exception of non-melanoma skin cancer are excluded if there is any evidence of other malignancy being present within the past five years.