Kathrin Kirchheiner1, Remi A Nout2, Jacob C Lindegaard3, Christine Haie-Meder4, Umesh Mahantshetty5, Barbara Segedin6, Ina M Jürgenliemk-Schulz7, Peter J Hoskin8, Bhavana Rai9, Wolfgang Dörr10, Christian Kirisits11, Søren M Bentzen12, Richard Pötter10, Kari Tanderup3. 1. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Austria. Electronic address: kathrin.kirchheiner@meduniwien.ac.at. 2. Department of Radiation Oncology, Leiden University Medical Center, The Netherlands. 3. Department of Oncology, Aarhus University Hospital, Denmark. 4. Department of Radiotherapy, Gustave-Roussy, Villejuif, France. 5. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. 6. Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia. 7. Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands. 8. Cancer Centre, Mount Vernon Hospital, London, UK. 9. Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 10. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria. 11. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Austria. 12. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA.
Abstract
BACKGROUND/ PURPOSE: To identify risk factors for vaginal stenosis and to establish a dose-effect relationship for image-guided brachytherapy in locally advanced cervical cancer. MATERIALS/ METHODS: Patients from the ongoing EMBRACE study with prospectively assessed morbidity (CTCAEv3.0) at baseline and at least one follow-up were selected. Patient-, disease- and treatment characteristics were tested as risk factors for vaginal stenosis G ⩾ 2 in univariate and multivariable analyses (Cox proportional hazards model) and a dose-effect curve was deduced from the estimates. The ICRU rectum point was used to derive the recto-vaginal reference point dose. RESULTS: In 630 patients included (median follow-up 24months), 2-year actuarial estimate for vaginal stenosis G ⩾ 2 was 21%. Recto-vaginal reference point dose (HR=1.025, p=0.029), external beam radiotherapy (EBRT) dose >45 Gy/25 fractions (HR=1.770, p=0.056) and tumor extension in the vagina (HR=2.259, p ⩽ 0.001) were risk factors for vaginal stenosis, adjusted for center reporting effects. Based on the model curve, the risk was 20% at 65 Gy, 27% at 75 Gy and 34% at 85 Gy (recto-vaginal reference point dose). CONCLUSION: Keeping the EBRT dose at 45 Gy/25 fractions and decreasing the dose contribution of brachytherapy to the vagina decrease the risk of stenosis. A planning aim of ⩽65 Gy EQD2 (EBRT+brachytherapy dose) to the recto-vaginal reference point is therefore proposed.
BACKGROUND/ PURPOSE: To identify risk factors for vaginal stenosis and to establish a dose-effect relationship for image-guided brachytherapy in locally advanced cervical cancer. MATERIALS/ METHODS:Patients from the ongoing EMBRACE study with prospectively assessed morbidity (CTCAEv3.0) at baseline and at least one follow-up were selected. Patient-, disease- and treatment characteristics were tested as risk factors for vaginal stenosis G ⩾ 2 in univariate and multivariable analyses (Cox proportional hazards model) and a dose-effect curve was deduced from the estimates. The ICRU rectum point was used to derive the recto-vaginal reference point dose. RESULTS: In 630 patients included (median follow-up 24months), 2-year actuarial estimate for vaginal stenosis G ⩾ 2 was 21%. Recto-vaginal reference point dose (HR=1.025, p=0.029), external beam radiotherapy (EBRT) dose >45 Gy/25 fractions (HR=1.770, p=0.056) and tumor extension in the vagina (HR=2.259, p ⩽ 0.001) were risk factors for vaginal stenosis, adjusted for center reporting effects. Based on the model curve, the risk was 20% at 65 Gy, 27% at 75 Gy and 34% at 85 Gy (recto-vaginal reference point dose). CONCLUSION: Keeping the EBRT dose at 45 Gy/25 fractions and decreasing the dose contribution of brachytherapy to the vagina decrease the risk of stenosis. A planning aim of ⩽65 Gy EQD2 (EBRT+brachytherapy dose) to the recto-vaginal reference point is therefore proposed.
Authors: John M Stahl; Jack M Qian; Christopher J Tien; David J Carlson; Zhe Chen; Elena S Ratner; Henry S Park; Shari Damast Journal: Support Care Cancer Date: 2018-09-05 Impact factor: 3.603
Authors: Junzo Chino; Christina M Annunziata; Sushil Beriwal; Lisa Bradfield; Beth A Erickson; Emma C Fields; KathrynJane Fitch; Matthew M Harkenrider; Christine H Holschneider; Mitchell Kamrava; Eric Leung; Lilie L Lin; Jyoti S Mayadev; Marc Morcos; Chika Nwachukwu; Daniel Petereit; Akila N Viswanathan Journal: Pract Radiat Oncol Date: 2020-05-18
Authors: Richard Pötter; Kari Tanderup; Christian Kirisits; Astrid de Leeuw; Kathrin Kirchheiner; Remi Nout; Li Tee Tan; Christine Haie-Meder; Umesh Mahantshetty; Barbara Segedin; Peter Hoskin; Kjersti Bruheim; Bhavana Rai; Fleur Huang; Erik Van Limbergen; Max Schmid; Nicole Nesvacil; Alina Sturdza; Lars Fokdal; Nina Boje Kibsgaard Jensen; Dietmar Georg; Marianne Assenholt; Yvette Seppenwoolde; Christel Nomden; Israel Fortin; Supriya Chopra; Uulke van der Heide; Tamara Rumpold; Jacob Christian Lindegaard; Ina Jürgenliemk-Schulz Journal: Clin Transl Radiat Oncol Date: 2018-01-11
Authors: María Del Valle Aguilera; Ángeles Rovirosa; Carlos Ascaso; Antonio Herreros; Joan Sánchez; Julia Garcia-Migue; Stephanía Cortes; Eduardo Agusti; Cristina Camacho; Yaowen Zhang; Yan Li; Sebastià Sabater; Aureli Torne; Meritxell Arenas Journal: J Contemp Brachytherapy Date: 2018-02-28
Authors: Kara D Romano; Colin Hill; Daniel M Trifiletti; M Sean Peach; Bethany J Horton; Neil Shah; Dylan Campbell; Bruce Libby; Timothy N Showalter Journal: Radiat Oncol Date: 2018-07-16 Impact factor: 3.481