Late G2 Vagina Toxicity in Post-operative Endometrial Carcinoma is Associated with a 68 Gy Dose Equivalent to 2 Gy Per Fraction at 2 Cm of Vagina

Overview

Journal J Contemp Brachytherapy

Date 2018 Apr 6

PMID 29619055

Citations 9

Authors

Maria Del Valle Aguilera

Angeles Rovirosa

Carlos Ascaso

Antonio Herreros

Joan Sanchez

Julia Garcia-Migue

Stephania Cortes

Eduardo Agusti

Cristina Camacho

Yaowen Zhang

Yan Li

Sebastia Sabater

Aureli Torne

Meritxell Arenas

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate if the dose equivalent to 2 Gy per fraction (EQD2) at 0.1 cm, 1 cm, and 2 cm of vagina in vaginal-cuff-brachytherapy (VBT) (high-dose-rate [HDR] Ir-source) ± external-beam-irradiation (EBRT) is associated with toxicity in post-operative endometrial carcinoma (P-EC).

Material And Methods: From June 2014 till November 2015, 67 consecutive P-EC patients underwent VBT ± EBRT; 44 patients received EBRT (median, 45 Gy; range, 44-50.4) + VBT (7 Gy), and 23 exclusive-VBT (6 Gy x 3 fractions). The upper 2.5 cm of vagina was delineated on computed tomography (CT). The active-length source was 2.5 cm, and the brachytherapy dose was prescribed at 5 mm from the applicator. D, V, and EQD2 at 0.1 cm, 1 cm, and 2 cm of the most exposed part of the vagina were calculated. Vaginal toxicity assessment was completed with a LENT-SOMA-objective-criteria. Statistics were done with the use of χ and Student's- test.

Results: The mean follow-up was 23.2 months (7.6-46.8). Median D90 was 7.8 Gy. Late toxicity: 8 G1 and 9 G2. Median EQD2 in vagina was 88.6 Gy (62.8-177.6) for 0.1 cm, 72.4 Gy (57.1-130.4) for 1 cm, and 69 Gy (53-113.4) for 2 cm. Exclusive VBT vs. EBRT+VBT showed no differences in vaginal toxicity. There was no relationship between EQD2 at 0.1 cm and 1 cm of vagina with G1-G2 toxicity ( = 0.62 and = 0.58, respectively). G2 toxicity was related to EQD2 at 2 cm ( = 0.03). EQD2 > 68 Gy caused G2 late toxicity in 20.5% patients. All patients presenting G2 toxicity received > 68 Gy EQD2.

Conclusions: More than 68 Gy EQD2 at 2 cm was related to G2 toxicity in P-EC-VBT. Further studies including larger number of patients are needed to confirm these results. Patients receiving these doses should be informed of the risk of toxicity, with individualized treatment planning and follow-up to reduce G2 toxicity.

Citing Articles

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Impact of Vaginal Dilator Use and 68 Gy EQD2 Dose Constraint on Vaginal Complications in External Beam Irradiation Followed by Brachytherapy in Post-Operative Endometrial Cancer.

Noorian F, Abellana R, Zhang Y, Herreros A, Lancellotta V, Tagliaferri L J Pers Med. 2024; 14(8).

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Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?.

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Arden J, Dokter J, Almahariq M, Marvin K, Nandalur S, Al-Wahab Z Adv Radiat Oncol. 2021; 6(6):100773.

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References

Bahng A, Dagan A, Bruner D, Lin L . Determination of prognostic factors for vaginal mucosal toxicity associated with intravaginal high-dose rate brachytherapy in patients with endometrial cancer. Int J Radiat Oncol Biol Phys. 2011; 82(2):667-73. DOI: 10.1016/j.ijrobp.2010.10.071. View

Rovirosa A, Ascaso C, Arenas M, Sabater S, Herreros A, Camarasa A . Can we shorten the overall treatment time in postoperative brachytherapy of endometrial carcinoma? Comparison of two brachytherapy schedules. Radiother Oncol. 2015; 116(1):143-8. DOI: 10.1016/j.radonc.2015.06.016. View

Kirchheiner K, Nout R, Lindegaard J, Haie-Meder C, Mahantshetty U, Segedin B . 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. Radiother Oncol. 2016; 118(1):160-6. DOI: 10.1016/j.radonc.2015.12.025. View

Valduvieco I, Rovirosa A, Herreros A, Romera I, Rios I, Ascaso C . Three or four fractions per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. The long-term results on vaginal relapses and toxicity. Clin Transl Oncol. 2012; 15(8):602-7. DOI: 10.1007/s12094-012-0974-0. View

Rovirosa A, Valduvieco I, Ascaso C, Herreros A, Bautista C, Romera I . Daily schedule for high-dose-rate brachytherapy in postoperative treatment of endometrial carcinoma. Clin Transl Oncol. 2012; 15(2):111-6. DOI: 10.1007/s12094-012-0893-0. View

Small Jr W, Mell L, Anderson P, Creutzberg C, De los Santos J, Gaffney D . Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2007; 71(2):428-34. PMC: 2752724. DOI: 10.1016/j.ijrobp.2007.09.042. View

Miles T, Johnson N . Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev. 2010; (9):CD007291. PMC: 4171967. DOI: 10.1002/14651858.CD007291.pub2. View

Laliscia C, Delishaj D, Fabrini M, Gonnelli A, Morganti R, Perrone F . Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit?. J Contemp Brachytherapy. 2017; 8(6):512-517. PMC: 5241378. DOI: 10.5114/jcb.2016.64511. View

. Late effects consensus conference: RTOG/EORTC. Radiother Oncol. 1995; 35(1):5-7. View

10.

Sorbe B, Smeds A . Postoperative vaginal irradiation with high dose rate afterloading technique in endometrial carcinoma stage I. Int J Radiat Oncol Biol Phys. 1990; 18(2):305-14. DOI: 10.1016/0360-3016(90)90094-z. View

11.

Potter R, Tanderup K, Kirisits C, De Leeuw A, Kirchheiner K, Nout R . The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018; 9:48-60. PMC: 5862686. DOI: 10.1016/j.ctro.2018.01.001. View

12.

Guinot J, Perez-Calatayud J, Azcoaga J, Herruzo I, Bodineau C, Rovirosa A . Consensus on treatment of endometrium carcinoma with brachytherapy. Clin Transl Oncol. 2012; 14(4):263-70. DOI: 10.1007/s12094-012-0794-2. View

13.

Susko M, Craciunescu O, Meltsner S, Yang Y, Steffey B, Cai J . Vaginal Dose Is Associated With Toxicity in Image Guided Tandem Ring or Ovoid-Based Brachytherapy. Int J Radiat Oncol Biol Phys. 2016; 94(5):1099-105. DOI: 10.1016/j.ijrobp.2015.12.360. View

14.

Westerveld H, De Leeuw A, Kirchheiner K, Dankulchai P, Oosterveld B, Oinam A . Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients. Radiother Oncol. 2016; 120(3):420-427. DOI: 10.1016/j.radonc.2016.05.002. View

15.

Kirchheiner K, Nout R, Tanderup K, Lindegaard J, Westerveld H, Haie-Meder C . Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study. Int J Radiat Oncol Biol Phys. 2014; 89(1):88-95. DOI: 10.1016/j.ijrobp.2014.01.032. View

16.

Limkin E, Dumas I, Rivin Del Campo E, Chargari C, Maroun P, Annede P . Vaginal dose assessment in image-guided brachytherapy for cervical cancer: Can we really rely on dose-point evaluation?. Brachytherapy. 2016; 15(2):169-76. DOI: 10.1016/j.brachy.2015.11.005. View

17.

Harkenrider M, Block A, Alektiar K, Gaffney D, Jones E, Klopp A . American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review. Brachytherapy. 2016; 16(1):95-108. PMC: 5612425. DOI: 10.1016/j.brachy.2016.04.005. View

18.

Friedman L, Abdallah R, Schluchter M, Panneerselvam A, Kunos C . Adherence to vaginal dilation following high dose rate brachytherapy for endometrial cancer. Int J Radiat Oncol Biol Phys. 2010; 80(3):751-7. DOI: 10.1016/j.ijrobp.2010.02.058. View

19.

Rovirosa A, Ascaso C, Sanchez-Reyes A, Herreros A, Abellana R, Pahisa J . Three or four fractions of 4-5 Gy per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2010; 81(2):418-23. DOI: 10.1016/j.ijrobp.2010.06.001. View

20.

Rios I, Rovirosa A, Ascaso C, Valduvieco I, Herreros A, Castilla L . Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients. Clin Transl Oncol. 2015; 18(9):925-30. DOI: 10.1007/s12094-015-1463-z. View