TY - JOUR
T1 - Dose-effect relationship between vaginal dose points and vaginal stenosis in cervical cancer
T2 - An EMBRACE-I sub-study
AU - Westerveld, Henrike
AU - Kirchheiner, Kathrin
AU - Nout, Remi A.
AU - Tanderup, Kari
AU - Lindegaard, Jacob C.
AU - Spampinato, Sofia
AU - Sturdza, Alina
AU - Nesvacil, Nicole
AU - Bruheim, Kjersti
AU - Hellebust, Taran P.
AU - Pieters, Bradley R.
AU - Kirisits, Christian
AU - Jürgenliemk-Schulz, Ina M.
AU - Pötter, Richard
AU - de Leeuw, Astrid A.C.
N1 - Funding Information:
The EMBRACE study was supported by Elekta AB and Varian Medical System through unrestricted research grants and study sponsoring through the Medical University of Vienna.
Publisher Copyright:
© 2021 Elsevier B.V.
Copyright © 2021 Elsevier B.V. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - Background and purpose: To evaluate dose–effect relationships between vaginal dose points and vaginal stenosis in patients treated for locally advanced cervical cancer with radio(chemo)therapy and image-guided adaptive brachytherapy. Material and methods: Patients from six centres participating in the EMBRACE-I study were included. Information on doses to different vaginal dose points, including the Posterior-Inferior Border of Symphysis (PIBS) points and recto-vaginal reference (RV-RP) point, were retrieved from the treatment planning system. In addition, the vaginal reference length (VRL) was evaluated. Vaginal stenosis was prospectively assessed according to the CTCAEv3.0 system at baseline and follow-up. Primary endpoint was grade 2 or higher (G ≥ 2) vaginal stenosis. Impact of dose to the vaginal dose points, and impact of VRL, age, vaginal involvement and applicator on vaginal stenosis G ≥ 2 was evaluated with a Cox proportional-hazard regression model. Results: 301 patients were included. Median follow-up was 49 months. During follow-up, the incidence of G0, G1, G2, and G3 vaginal stenosis was 25% (76), 52% (158), 20% (59) and 3% (8), respectively. Median total doses to PIBS+2 cm, PIBS, PIBS-2 cm and the RV-RP were 52.9 (IQR 49.3–64.7), 41.0 (IQR 15.4–49.0), 4.1 (IQR 2.9–7.0) and 64.6 (IQR 60.0–70.6) Gy EQD23, respectively. Higher doses to the PIBS, PIBS + 2 cm and RV-RP points were significantly associated with increased risk for vaginal stenosis G ≥ 2. Other risk factors for vaginal stenosis were: vaginal involvement at diagnosis, higher age, shorter VRL and use of a tandem-ovoid applicator. Conclusion: Higher doses to the PIBS+2 cm, PIBS and RV-RP dose points are associated with vaginal stenosis G ≥ 2.
AB - Background and purpose: To evaluate dose–effect relationships between vaginal dose points and vaginal stenosis in patients treated for locally advanced cervical cancer with radio(chemo)therapy and image-guided adaptive brachytherapy. Material and methods: Patients from six centres participating in the EMBRACE-I study were included. Information on doses to different vaginal dose points, including the Posterior-Inferior Border of Symphysis (PIBS) points and recto-vaginal reference (RV-RP) point, were retrieved from the treatment planning system. In addition, the vaginal reference length (VRL) was evaluated. Vaginal stenosis was prospectively assessed according to the CTCAEv3.0 system at baseline and follow-up. Primary endpoint was grade 2 or higher (G ≥ 2) vaginal stenosis. Impact of dose to the vaginal dose points, and impact of VRL, age, vaginal involvement and applicator on vaginal stenosis G ≥ 2 was evaluated with a Cox proportional-hazard regression model. Results: 301 patients were included. Median follow-up was 49 months. During follow-up, the incidence of G0, G1, G2, and G3 vaginal stenosis was 25% (76), 52% (158), 20% (59) and 3% (8), respectively. Median total doses to PIBS+2 cm, PIBS, PIBS-2 cm and the RV-RP were 52.9 (IQR 49.3–64.7), 41.0 (IQR 15.4–49.0), 4.1 (IQR 2.9–7.0) and 64.6 (IQR 60.0–70.6) Gy EQD23, respectively. Higher doses to the PIBS, PIBS + 2 cm and RV-RP points were significantly associated with increased risk for vaginal stenosis G ≥ 2. Other risk factors for vaginal stenosis were: vaginal involvement at diagnosis, higher age, shorter VRL and use of a tandem-ovoid applicator. Conclusion: Higher doses to the PIBS+2 cm, PIBS and RV-RP dose points are associated with vaginal stenosis G ≥ 2.
KW - Brachytherapy
KW - Cervical cancer
KW - Dose-effect
KW - EMBRACE
KW - ICRU-R
KW - PIBS
KW - Radiotherapy
KW - RV-RP
KW - Vaginal morbidity
KW - Radiotherapy Dosage
KW - Constriction, Pathologic/etiology
KW - Humans
KW - Vagina
KW - Brachytherapy/adverse effects
KW - Uterine Cervical Neoplasms/radiotherapy
KW - Female
UR - http://www.scopus.com/inward/record.url?scp=85123620766&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2021.12.034
DO - 10.1016/j.radonc.2021.12.034
M3 - Article
C2 - 35063582
AN - SCOPUS:85123620766
SN - 0167-8140
VL - 168
SP - 8
EP - 15
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -