Sandy Mohamed1, Jacob Christian Lindegaard2, Astrid A C de Leeuw3, Ina Jürgenliemk-Schulz3, Kathrin Kirchheiner4, Christian Kirisits4, Richard Pötter4, Kari Tanderup5. 1. Department of Oncology, Aarhus University Hospital, Denmark; Department of Radiotherapy, NCI, Cairo University, Egypt. Electronic address: sandy.mohamed@nci.cu.edu.eg. 2. Department of Oncology, Aarhus University Hospital, Denmark. 3. Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands. 4. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria. 5. Institute of Clinical Medicine, Aarhus University, Denmark.
Abstract
PURPOSE: Vaginal stenosis is a major problem following radiotherapy in cervical cancer. We investigated a new dose planning strategy for vaginal dose de-escalation (VDD). MATERIALS AND METHODS: Fifty consecutive locally advanced cervical cancer patients without lower or middle vaginal involvement at diagnosis from 3 institutions were analysed. External beam radiotherapy was combined with MRI-guided brachytherapy. VDD was obtained by decreasing dwell times in ovoid/ring and increasing dwell times in tandem/needles. The aim was to maintain the target dose (D90 of HR-CTV⩾85Gy EQD2) while reducing the dose to the surface of the vagina to <140% of the physical fractional brachytherapy dose corresponding to a total EQD2 of 85Gy. RESULTS: The mean vaginal loading (ovoid/ring) was reduced from 51% to 33% of the total loading with VDD, which significantly reduced the dose to the vaginal dose points (p<0.001) without compromising the target dose. The dose to the ICRU recto-vaginal point was reduced by a mean of 4±4Gy EQD2 (p<0.001), while doses to bladder and rectum (D2cm3) were reduced by 2±2Gy and 3±2Gy, respectively (p<0.001). CONCLUSIONS: VDD significantly reduces dose to the upper vagina which is expected to result in reduction of vaginal stenosis.
PURPOSE:Vaginal stenosis is a major problem following radiotherapy in cervical cancer. We investigated a new dose planning strategy for vaginal dose de-escalation (VDD). MATERIALS AND METHODS: Fifty consecutive locally advanced cervical cancerpatients without lower or middle vaginal involvement at diagnosis from 3 institutions were analysed. External beam radiotherapy was combined with MRI-guided brachytherapy. VDD was obtained by decreasing dwell times in ovoid/ring and increasing dwell times in tandem/needles. The aim was to maintain the target dose (D90 of HR-CTV⩾85Gy EQD2) while reducing the dose to the surface of the vagina to <140% of the physical fractional brachytherapy dose corresponding to a total EQD2 of 85Gy. RESULTS: The mean vaginal loading (ovoid/ring) was reduced from 51% to 33% of the total loading with VDD, which significantly reduced the dose to the vaginal dose points (p<0.001) without compromising the target dose. The dose to the ICRU recto-vaginal point was reduced by a mean of 4±4Gy EQD2 (p<0.001), while doses to bladder and rectum (D2cm3) were reduced by 2±2Gy and 3±2Gy, respectively (p<0.001). CONCLUSIONS: VDD significantly reduces dose to the upper vagina which is expected to result in reduction of vaginal stenosis.
Authors: Taylor J Corriher; Sunil W Dutta; Clayton E Alonso; Bruce Libby; Kara D Romano; Timothy N Showalter Journal: J Contemp Brachytherapy Date: 2020-06-30
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: Sati Akbaba; Jan Tobias Oelmann-Avendano; Tilman Bostel; Harald Rief; Nils Henrik Nicolay; Juergen Debus; Katja Lindel; Robert Foerster Journal: Radiol Oncol Date: 2018-09-11 Impact factor: 2.991