Comparison of Acute Toxicities Between Patients Treated With Protons or Intensity Modulated Radiation Therapy After Surgery for the Treatment of Endometrial or Cervical Cancer

  • End date
    Oct 15, 2024
  • participants needed
  • sponsor
    Mayo Clinic
Updated on 9 July 2022
computed tomography
tumor cells
inflammatory disease
plain x-ray


This early phase I trial compares the side effects between patients treated with proton radiation therapy versus intensity modulated radiation therapy after surgery for the treatment of endometrial or cervical cancer. Radiation therapy uses high energy protons or x-rays to kill tumor cells and shrink tumors. Using quality of life questionnaires and adverse event assessments may help doctors learn whether proton radiation therapy is associated with lower acute gastrointestinal toxicities at the end of treatment compared to intensity modulated radiation therapy in patients with endometrial or cervical cancer.



I. To assess whether proton radiation therapy (RT) is associated with lower acute gastrointestinal toxicities at the end of treatment compared to intensity modulated radiation therapy (IMRT) as measured with the Expanded Prostate Cancer Index Composite (EPIC) bowel domain.


I. To examine the association of bowel and bladder dose-volume histogram (DVH) with bowel and bladder toxicities, respectively.

II. To assess whether urinary toxicity rate is improved with proton RT compared to IMRT as measured with the EPIC urinary domain.

III. To determine if well-being is improved with proton RT compared to IMRT as measured by the Functional Assessment of Cancer Therapy (FACT) cervix domain.

IV. To determine if proton RT reduces grade 2+ hematologic toxicities (Common Terminology Criteria for Adverse Events [CTCAE] version [v] 4.0) compared to IMRT.

V. Evaluate progression-free and overall survival between patients receiving proton RT and IMRT.

VI. To determine if proton RT improves overall patient quality of life compared to IMRT using the European Quality of Life Five Dimension (EQ-5D) questionnaire.


I. Evaluate ability to tolerate chemotherapy concurrent or after RT. II. Correlate bone marrow DVH with blood marrow function, and ability to tolerate chemotherapy concurrently or after RT.

III. Correlate bowel and skin DVH with acute toxicity. IV. To evaluate patient-reported gastrointestinal (GI) toxicities as a predictor of assigned treatment regimen, as well as physician-reported GI toxicities as a predictor of assigned treatment regimen.

V. Confirm the validity of the EPIC bowel and urinary domains when referencing the last 7 days.


Patients undergo standard of care proton or intensity modulated radiation therapy. Patients also complete quality of life questionnaires and adverse event assessments over 10-15 minutes each at baseline, at the end of radiation therapy, and at 1 month, 1 year, and 3 years post-radiation therapy.

Condition Cervical Carcinoma, Endometrial Carcinoma, Endometriosis, Pelvic Inflammatory Disease
Treatment radiation therapy, questionnaire administration, quality-of-life assessment
Clinical Study IdentifierNCT04567771
SponsorMayo Clinic
Last Modified on9 July 2022


Yes No Not Sure

Inclusion Criteria

Histologically confirmed diagnosis of cervical or endometrial cancer
Must have undergone an open or robotic hysterectomy (total abdominal, vaginal, radical, or total laparoscopic) for carcinoma of the cervix or endometrium
History and physical prior to registration
Documentation of history of
Smoking status
Pelvic infection
Pelvic inflammatory disease
Planned to receive either proton or IMRT radiation treatment, with use of rectal
Plan for RT to pelvis with or without para-aortic lymph node irradiation
balloon, at an Institutional Review Board (IRB)-approved Mayo Clinic site
If received high-dose chemotherapy prior to registration, last dose must have been given >= 21 days prior to start of RT
Complete blood count (CBC) performed within 21 days prior to registration
Computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, or PET/MRI for staging before registration; may be pre-operative (op) or post-op
Eastern Cooperative Oncology Group (ECOG) performance score 0-2
Provide written informed consent
Willing to complete quality of life (QOL) questionnaires

Exclusion Criteria

Receiving external beam boost dose during RT
Distant metastases
Gross disease at time of RT
Histology of endometrial stromal sarcoma, leiomyosarcoma, melanoma or small cell carcinomas
Patients who exceed the weight/size limits of the treatment table
Patients with active and/or inflammatory irritable bowel disease
Positive or close surgical margins (=< 3 mm)
Prior RT to the pelvis
Planned to receive inguinal node RT
Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note that human immunodeficiency virus (HIV) testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be immunosuppressive
Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years
Severe, active co-morbidity defined as follows
Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
Transmural myocardial infarction within the last 6 months
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
Patients unwilling to have rectal balloon placed on a daily basis during RT
Other major medical illness which requires hospitalization or precludes study therapy
at the time of registration
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