TY - JOUR
T1 - Importance of the ICRU bladder point dose on incidence and persistence of urinary frequency and incontinence in locally advanced cervical cancer
T2 - An EMBRACE analysis
AU - Spampinato, Sofia
AU - Fokdal, Lars U.
AU - Pötter, Richard
AU - Haie-Meder, Christine
AU - Lindegaard, Jacob C.
AU - Schmid, Maximilian P.
AU - Sturdza, Alina
AU - Jürgenliemk-Schulz, Ina M.
AU - Mahantshetty, Umesh
AU - Segedin, Barbara
AU - Bruheim, Kjersti
AU - Hoskin, Peter
AU - Rai, Bhavana
AU - Huang, Fleur
AU - Cooper, Rachel
AU - van der Steen-Banasik, Elzbieta
AU - Van Limbergen, Erik
AU - Sundset, Marit
AU - Westerveld, Henrike
AU - Nout, Remi A.
AU - Jensen, Nina B.K.
AU - Kirisits, Christian
AU - Kirchheiner, Kathrin
AU - Tanderup, Kari
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 . The work of this manuscript was supported via grants from the Danish Cancer Society ( R101-A685414-S31 , R150-A10177-001 , R146-A9459-16-S2 ).
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/5
Y1 - 2021/5
N2 - Purpose: To identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methods: Physician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC “very much” and “quite a bit” or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ “quite a bit” were scored in at least half of follow-ups. Results: Longitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D2cm3. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose. Conclusion: ICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose–effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes.
AB - Purpose: To identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methods: Physician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC “very much” and “quite a bit” or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ “quite a bit” were scored in at least half of follow-ups. Results: Longitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D2cm3. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose. Conclusion: ICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose–effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes.
KW - Cervical cancer
KW - Clinical study
KW - Dose-effect relationship
KW - IGABT
KW - Risk factors
KW - Urinary morbidity
UR - http://www.scopus.com/inward/record.url?scp=85095564125&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2020.10.003
DO - 10.1016/j.radonc.2020.10.003
M3 - Article
C2 - 33065183
AN - SCOPUS:85095564125
SN - 0167-8140
VL - 158
SP - 300
EP - 308
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -