Phase 1/2 MR‑guided adaptive IMRT (MR‑linac–based pelvic radiation) after surgery in high‑risk endometrial cancer

Rutgers Cancer Institute of New Jersey (Rutgers University) is running this Phase 1/2 feasibility study to test whether daily MRI‑guided, online adaptive pelvic IMRT can be delivered safely and consistently as adjuvant therapy for higher‑risk endometrial cancer features (including high‑grade disease, pelvic node positivity, and/or cervical stromal invasion). The intervention is MR‑guided adaptive external‑beam radiotherapy on an MR‑linac: onboard MRI each day is used to adapt (replan) the IMRT dose to anatomic changes, aiming to improve target coverage while reducing dose to bowel, bladder, and other organs at risk. The regimen is moderately hypofractionated (42 Gy in 15 fractions), with optional vaginal brachytherapy afterward per institutional practice. The key scientific angle is operational and dosimetric: demonstrating that “daily adaptive” MR‑guided pelvic RT is practical in the post‑op setting where bowel/bladder motion is a major toxicity driver. Today’s care for these post‑hysterectomy higher‑risk patients is adjuvant pelvic EBRT (often CT‑planned IMRT) with selective use of vaginal brachytherapy and systemic chemotherapy depending on stage/risk, and this study probes whether MR‑guided adaptation can maintain disease control while potentially lowering GI/GU toxicity.