***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE Patients with completely resected high-risk endometrial cancer have a risk of disease recurrence even with the addition of adjuvant pelvic radiotherapy ( RT ) . A Phase II study was completed by the Radiation Therapy Oncology Group to assess the safety and toxicity of chemotherapy when combined with pelvic RT for these patients . METHODS AND MATERIAL S Eligibility requirements included a total abdominal hysterectomy and bilateral salpingo-oophorectomy with Grade 2 or 3 endometrial adenocarcinoma with > 50 % myometrial invasion , stromal invasion of the cervix , or pelvic-confined extrauterine disease . This study was design ed to administer 4500 cGy in 25 fractions to the pelvis , along with cisplatin ( 50 mg/m(2 ) ) on Days 1 and 28 . Vaginal brachytherapy with a low-dose-rate applicator ( 1 x 20 Gy to the surface ) or high-dose-rate applicator ( 3 x 6 Gy to the surface ) was performed after external beam RT . Four courses of cisplatin ( 50 mg/m(2 ) ) and paclitaxel ( 175 mg/m(2 ) ) were given at 4-week intervals after RT completion . RESULTS Forty-six patients were entered between October 1997 and April 1999 . Two patients were ineligible ( one with previous bladder cancer and one who had undergone surgery > 8 weeks before the start of RT ) . Follow-up ranged from 6.9 to 48.8 months ( median , 28.7 months ) . The disease was Stage III , II , and I in 66 % , 16 % , and 18 % of patients , respectively . Two patients were not assessable because of incomplete treatment data . The protocol completion rate was 98 % ( 41 of 42 assessable patients ) . Acute toxicity during RT/chemotherapy was Grade 1 in 27 % , Grade 2 in 43 % , Grade 3 in 27 % , and Grade 4 in 2 % . During adjuvant chemotherapy , the toxicity was Grade 1 in 7 % , Grade 2 in 7 % , Grade 3 in 21 % , and Grade 4 in 62 % . Severe toxicity was primarily hematologic . Chronic toxicity was Grade 1 in 20 % , Grade 2 in 39 % , Grade 3 in 16 % , and Grade 4 in 2 % , including 1 patient with a Grade 4 small bowel complication . At 24 months , the pelvic recurrence , regional recurrence , distant recurrence , disease-free survival , and overall survival rate was 2 % , 3 % , 17 % , 83 % , and 90 % , respectively . CONCLUSION This treatment protocol demonstrated an excellent treatment completion rate and expected toxicity . Longer follow-up is needed to assess the outcome . To assess the efficacy of this adjuvant treatment program , a Phase III trial ( Radiation Therapy Oncology Group 9905 ) was design ed with high-risk uterine-confined disease to be r and omized between pelvic RT alone and pelvic RT with chemotherapy BACKGROUND Postoperative radiotherapy for International Federation of Gynaecology and Obstetrics ( FIGO ) stage-1 endometrial carcinoma is a subject of controversy due to the low relapse rate and the lack of data from r and omised trials . We did a multicentre prospect i ve r and omised trial to find whether postoperative pelvic radiotherapy improves locoregional control and survival for patients with stage-1 endometrial carcinoma . METHODS Patients with stage-1 endometrial carcinoma ( grade 1 with deep [ > or = 50 % ] myometrial invasion , grade 2 with any invasion , or grade 3 with superficial [ < 50 % ] invasion ) were enrolled . After total abdominal hysterectomy and bilateral salpingo-oophorectomy , without lymphadenectomy , 715 patients from 19 radiation oncology centres were r and omised to pelvic radiotherapy ( 46 Gy ) or no further treatment . The primary study endpoints were locoregional recurrence and death , with treatment-related morbidity and survival after relapse as secondary endpoints . FINDINGS Analysis was done according to the intention-to-treat principle . Of the 715 patients , 714 could be evaluated . The median duration of follow-up was 52 months . 5-year actuarial locoregional recurrence rates were 4 % in the radiotherapy group and 14 % in the control group ( p<0.001 ) . Actuarial 5-year overall survival rates were similar in the two groups : 81 % ( radiotherapy ) and 85 % ( controls ) , p=0.31 . Endometrial-cancer-related death rates were 9 % in the radiotherapy group and 6 % in the control group ( p=0.37 ) . Treatment-related complications occurred in 25 % of radiotherapy patients , and in 6 % of the controls ( p<0.0001 ) . Two-thirds of the complications were grade 1 . Grade 3 - 4 complications were seen in eight patients , of which seven were in the radiotherapy group ( 2 % ) . 2-year survival after vaginal recurrence was 79 % , in contrast to 21 % after pelvic recurrence or distant metastases . Survival after relapse was significantly ( p=0.02 ) better for patients in the control group . Multivariate analysis showed that for locoregional recurrence , radiotherapy and age below 60 years were significant favourable prognostic factors . INTERPRETATION Postoperative radiotherapy in stage-1 endometrial carcinoma reduces locoregional recurrence but has no impact on overall survival .  Radiotherapy increases treatment-related morbidity .  Postoperative radiotherapy is not indicated in patients with stage-1 endometrial carcinoma below 60 years and patients with grade -2 tumours with superficial invasion AIM During the last decades , therapies targeting cervical cancer have been considerably improved . Surgery and radiotherapy ( RT ) represent the main common therapeutic approach in cervical cancer . In order to minimize the side effects of radiotherapy approach , several protocol s have been developed such as brachytherapy ( BRT ) . Among the side effects associated with RT , the vaginal atrophy is the most important and common one . Vaginal atrophy , in turn , leads to additional alterations like inflammation , associated to relevant symptoms such as itching , burning and dyspareunia . All these alterations heavily affect the quality of women 's life . The aim of our study was to evaluate the toxicity induced by RT on vaginal mucosa , and the adjuvant action of a product containing LMWHA , vitamin A , and Vitamin E ( Santes ® , Lo . Li . Pharma , Rome , Italy ) . The introduction of adjuvant therapies may have likely had a relevant place in providing that result . METHODS A prospect i ve r and omized study was design ed . From October 2006 to October 2008 , 45 women with a mean age 38 ± 6 years were enrolled . After surgery , all patients were treated with 4 weeks of RT and 4 weeks of BRT , concomitantly with chemiotherapy . They were r and omly assigned in two groups : 23 women were treated with two suppositories ( Santes ® ) per day for 4 months . For the first two months the preventive treatment was simultaneous to RT and BRT . Instead the control groups for composed by 22 patients and they did not undergo any treatment during RT . To evaluate the efficacy of Santes ® treatment three biopsies were performed . RESULTS At the second biopsy , after the BRT therapy , the treated group showed a statistically significant improvement ( P<0.05 vs. control ) on inflammation , cell atypia , fibrosis , mucositis and bleeding . At the third biopsy , two months after BRT , further statistically improvement were observed for all RT/BRT associated side effects . The treatment showed an efficacy also in terms of pain severity . CONCLUSION Our data suggest that low molecular weight HA shows good performances in treating RT-damaged tissue and plays a key role in all steps of the healing process . Indeed the results shows that women exposed to RT treatments and simultaneously treated with Santes ® , had an optimal resolution of vaginal atrophy and related symptoms Purpose The aim of the present study was to evaluate the effectiveness of hyaluronic acid ( HA ) in the prevention of acute and late vaginal toxicities after high-dose-rate ( HDR ) vaginal brachytherapy ( BT ) . Material and methods Between January 2011 and January 2015 , we retrospectively analyzed 126 patients with endometrial cancer who underwent extrafascial hysterectomy with or without lymphadenectomy and adjuvant HDR-vaginal BT + /– adjuvant chemotherapy .  The total dose prescription was 21 Gy in 3 fractions ( one fraction for week ) . Vaginal ovules containing 5 mg of HA were given for whole duration of vaginal BT and for the two following weeks . Acute and late toxicities were evaluated according to CTCAE vs 4.02 . Results According to the revised FIGO 2009 classification , most tumors were in stage IA ( 30.9 % ) and in stage IB ( 57.9 % ) . Thirty-three patients ( 26.2 % ) received adjuvant chemotherapy before vaginal BT . Five-year disease-free survival ( DFS ) and five-year overall survival ( OS ) were 88 % and 93 % , respectively . The most common grade 1 - 2 acute toxicities were vaginal inflammation ( 18 patients , 14.3 % ) and dyspareunia ( 7 patients , 5.5 % ) . Two patients ( 1.6 % ) had more than one toxicity . Late toxicity occurred in 20 patients ( 15.9 % ) . Grade 1 - 2 late toxicities were fibrosis ( 14 patients , 11.1 % ) and telangiectasias ( 7 patients , 5.5 % ) . Six patients ( 4.8 % ) had more than one late toxicity . No grade 3 or higher acute or late toxicities were observed . Conclusions These results appear to suggest that the local therapy with HA is of clinical benefit for intermediate risk endometrial cancer patients who receive adjuvant HDR-vaginal BT after surgery . A r and omized trial comparing HA treatment vs. no local treatment in this clinical setting is warranted to further evaluate the efficacy of HA in preventing vaginal BT-related vaginal toxicity PURPOSE To compare two different fractionation schedules for postoperative vaginal high-dose-rate ( HDR ) irradiation in endometrial carcinomas . METHODS AND MATERIAL S In a complete geographic series of 290 low-risk endometrial carcinomas , the efficacy and side effects of two different fractionation schedules for postoperative vaginal irradiation were evaluated . The patients were treated during the years 1989 - 2003 . The tumors were in International Federation of Gynecology and Obstetrics Stages IA-IB and Grade s 1 - 2 . The HDR MicroSelectron afterloading equipment ( iridium-192 ) was used . Perspex vaginal applicators with diameters of 20 - 30 mm were used , and the dose was specified at 5 mm from the surface of the applicator . Six fractions were given , and the overall treatment time was 8 days . The size of the dose per fraction was r and omly set to 2.5 Gy ( total dose of 15.0 Gy ) or 5.0 Gy ( total dose of 30.0 Gy ) . One hundred forty-four patients were treated with the 2.5-Gy fraction and 146 patients with the 5.0-Gy fraction . RESULTS The overall locoregional recurrence rate of the complete series was 1.4 % and the rate of vaginal recurrences 0.7 % . There was no difference between the two r and omized groups . The vaginal shortening measured by colpometry was not significant ( p = 0.159 ) in the 2.5-Gy group ( mean , 0.3 cm ) but was highly significant ( p < 0.000001 ) in the 5.0-Gy group ( mean 2.1 cm ) after 5 years . Mucosal atrophy and bleedings were significantly more frequent in the 5.0-Gy group . Symptoms noted in the 2.5-Gy group were not different from what could be expected in a normal group of postmenopausal women . CONCLUSION The fractionation schedule recommended for postoperative vaginal irradiation in low-risk endometrial carcinoma is six fractions of 2.5 Gy when the HDR technique is used OBJECTIVE To determine the progression free survival ( PFS ) , toxicity , and patterns of failure for early stage , high-intermediate risk ( H-IR ) patients in a phase II trial with adjuvant vaginal cuff brachytherapy ( VCB )  and three cycles of carboplatin and paclitaxel . METHODS Surgically staged patients with stage I-IIb endometrial cancer with H-IR factors were treated with VCB ( 2100cGy ) followed by three cycles of carboplatin ( AUC 6 ) and paclitaxel ( 175 mg/m(2 ) ) . The primary endpoint was PFS at 2 years , with toxicity and sites of failure as secondary endpoints . Toxicity was assessed by patient report ( CTCAE v. 3 ) as well as by delays or dose modifications in treatment . RESULTS 
    Output:
    
The most common early side effects due to HDR-BT treatment were vaginal inflammation , vaginal irritation , dryness , discharge , soreness , swelling , and fungal infection .
The most common late side effects consisted of vaginal discharge , dryness , itching , bleeding , fibrosis , telangiectasias , stenosis , short or narrow vagina , and dyspareunia .
Conclusions The data suggest that HDR endovaginal brachytherapy , with or without chemotherapy , is very well tolerated with low rates of acute and late vaginal toxicities .