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    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2016 Jan 9. pii: S0167-8140(16)00002-5. doi: 10.1016/j.radonc.2015.12.025
    Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study.
    Kirchheiner K1,  Nout RA2,  Lindegaard JC3,  Haie-Meder C4,  Mahantshetty U5,  Segedin B6,  Jürgenliemk-Schulz IM7,  Hoskin PJ8,  Rai B9,  Dörr W10,  Kirisits C11,  Bentzen SM12,  Pötter R13,  Tanderup K14
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    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 >45Gy/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 65Gy, 27% at 75Gy and 34% at 85Gy (recto-vaginal reference point dose).

    CONCLUSION: Keeping the EBRT dose at 45Gy/25 fractions and decreasing the dose contribution of brachytherapy to the vagina decrease the risk of stenosis. A planning aim of ⩽65Gy EQD2 (EBRT+brachytherapy dose) to the recto-vaginal reference point is therefore proposed.


    Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

    KEYWORDS: ICRU recto-vaginal point, Image-guided brachytherapy, Radiotherapy, Vaginal morbidity, Vaginal shortening/narrowing

    Publikations ID: 26780997
    Quelle: öffnen
     
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