A Study of Short-course Hypofractionated Online-adaptive Radiotherapy for the Post-operative Treatment of Endometrial Cancer: Tolerability and Feasibility

The goal of this clinical trial is to assess the safety and feasibility of using a new form of radiotherapy technology, known as CT online-adaptive radiotherapy, to reduce the number of treatment sessions required in post-operative radiotherapy for patients with endometrial cancer, from 25 sessions over 5 weeks to 5 sessions over a week and a half. The main questions it seeks to answer are: * If it is safe to deliver the radiotherapy in a smaller number of treatment sessions with a larger dose per session by utilising the CT online-adaptive technology * If it is feasible for this treatment to be delivered using the CT online-adaptive technology in a clinical trial All participants who enrol in the study would be offered the trial treatment of the radiotherapy being delivered in 5 sessions. Any potential participants who are subsequently found to be ineligible during the radiotherapy planning process would be excluded from the trial treatment of a higher dose over 5 sessions, but would still be offered the CT online-adaptive technology over 25 sessions outside of the trial. Participants would undergo the trial treatment with the radiotherapy being delivered in 5 sessions over a week and a half using the CT online-adaptive technology, with any issues during the treatment delivery recorded, and a questionnaire to complete at the end of treatment to see how the new technology was tolerated by participants. Participants will have their side effects recorded by the trial team before, during and after their treatment for 2 years following the radiotherapy. During this time period participants will also be asked to complete patient questionnaires to assess their perception of side effects and their quality-of-life after undergoing the treatment. Participants will also have blood tests before, during and after the radiotherapy for 3 months to check for any potential problems with blood counts as a result of the trial treatment. During the 2 years of follow-up after the radiotherapy, participants will also have assessments for if the cancer has returned, which will be completed by a combination of clinical examination, and CT scans. Following completion of the 2 years of trial follow-up, participants would remain on general follow-up to assess for if the cancer has returned, or for any longer term side effects for up to 5 years after the treatment, but this follow-up will be outside of the trial without the request for ongoing completion of participant questionnaires.

Sex

Female

Minimum age

18 Years

Inclusion criteria

1. Histologically confirmed endometrial carcinoma - inclusive of endometrioid adenocarcinoma, carcinosarcoma, clear cell carcinoma, serous carcinoma, dedifferentiated carcinoma, mucinous carcinoma, mixed carcinoma
2. Age greater than 18 years old
3. Disease fully resected at time of surgery
4. Indication for post-operative external beam radiotherapy: high-intermediate risk and high-risk disease (ESGO-ESTRO-ESP guideline), or at the discretion of treating Clinical Oncologist
5. If adjuvant systemic chemotherapy is indicated, participants will still be eligible for trial participation, provided there is a minimum 3-week gap between completing chemotherapy and beginning external beam radiotherapy
6. If adjuvant vaginal vault brachytherapy boost is indicated, participants will still be eligible for trial participation, with a minimum gap of 1 day from completion of external beam radiotherapy to first fraction of brachytherapy
7. WHO Performance Status 0 - 2
8. Informed written consent

Exclusion criteria

1. Previous pelvic radiotherapy
2. Contraindication to receiving external beam radiotherapy
3. Residual disease identified on post-operative imaging
4. FIGO 2023 Stage 3C2 disease requiring extended para-aortic treatment field
5. Hip prostheses or other metal work within the imaging field which would produce significant imaging artifact
6. Indication for adjuvant concurrent chemo-radiotherapy