Pulsed-dose rate image-guided adaptive brachytherapy in cervical cancer: Dose–volume effect relationships for the rectum and bladder. Issue 2 (August 2015)

• Record Type: Journal Article
• Authors: Mazeron, Renaud; Maroun, Pierre; Castelnau-Marchand, Pauline; Dumas, Isabelle; del Campo, Eleonor Rivin; Cao, Kim; Slocker-Escarpa, Andrea; M'Bagui, Rodrigue; Martinetti, Florent; Tailleur, Anne; Guemnie-Tafo, Alain; Morice, Philippe; Chargari, Cyrus; Lefkopoulos, Dimitri; Haie-Meder, Christine
• Is Part Of: Radiotherapy and oncology. Volume 116:Issue 2(2015:Aug.)
• Page Start: 226
• Page End: 232
• Publication Date: 2015-08
• Subjects: Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.06.027
• Languages: English
• ISSNs: 0167-8140

Abstract

<abstract xml:lang="en" abstract-type="author" id="ab005"> <title id="st005">Abstract</title> <sec> <title id="st010">Purpose</title> <p id="sp0005">To establish dose–volume effect correlations for late bladder and rectum side effects in patients treated for locally advanced cervical cancer with concomitant chemoradiation followed by pulsed-dose rate image-guided adaptive brachytherapy.</p> </sec> <sec> <title id="st015">Material and methods</title> <p id="sp0010">The dosimetric data, converted in 2 Gy equivalent, from 217 patients were confronted to late morbidity defined as any event lasting or occurring 90 days after treatment initiation. Toxicity was assessed using the CTC-AE 3.0. Probit analyses and Log rank tests were performed to assess relationships.</p> </sec> <sec> <title id="st020">Results</title> <p id="sp0015">One hundred and sixty-one urinary and 58 rectal events were reported, affecting 98 (45.1%) and 51 (23.5%) patients, respectively. Cumulative incidences for grade 2–4 bladder and rectal morbidity were 24.3% and 9.6% at 3 years, respectively. Significant relationships were observed between grade 2–4 and 3–4 events and D0.1 cm<sup>3</sup> and D2 cm<sup>3</sup> for the bladder and between grade 1–4 and 2–4 event probability and rectal D2 cm<sup>3</sup>. The effective doses for 10% grade 2–4 morbidity were 65.3 Gy (59.8–81.3), and 55.4 Gy (15.7–63.6), respectively, for the rectum and bladder. Without considering urinary and rectal incontinence, for which the pertinence of correlating them with D2 cm<sup>3</sup> is questionable, ED10 were 68.5 Gy (62.9–110.6) and 65.5 Gy (51.4–71.6 Gy). When sorting patients according to D2 cm<sup>3</sup> levels, patients with high D2 cm<sup>3</sup> had significantly lower morbidity free survival rates for grade 1–4 and 2–4 urinary and rectal morbidity.</p> </sec> <sec> <title id="st025">Conclusion</title> <p id="sp0020">Significant dose–volume effect relationships were demonstrated between the modern dosimetric parameters and the occurrence of late rectal and urinary morbidity in patients treated with pulsed-dose-rate brachytherapy. Further studies are required to refine these relationships according to clinical cofactors, such as comorbidities.</p> </sec> </abstract>