Late toxicity of brachytherapy after female genital tract tumors treated during childhood: Prospective evaluation with a long-term follow-up. Issue 2 (November 2015)

• Record Type: Journal Article
• Authors: Levy, Antonin; Martelli, Helene; Fayech, Chiraz; Minard-Colin, Veronique; Dumas, Isabelle; Gensse, Marie-Catherine; Le Deley, Marie-Cecile; Oberlin, Odile; Haie-Meder, Christine
• Is Part Of: Radiotherapy and oncology. Volume 117:Issue 2(2015:Nov.)
• Page Start: 206
• Page End: 212
• Publication Date: 2015-11
• Subjects: Genital tract cancer -- Gynecology -- Long-term toxicity -- Quality of life -- Brachytherapy -- Childhood cancer; 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.2015.09.025
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Purpose: To prospectively assess the long-term toxicities of brachytherapy in female survivors with localized genital tract tumors. Patients and methods: The data concerning 42 patients treated at Gustave Roussy between 1971 and 2004, were both retrospectively and prospectively analyzed. Strictly confidential constructed surveys based on the LENT SOMA/SF-36v2 questionnaires were mailed and 51% were completed. Complications were recorded throughout the follow-up period and graded according to CTCAE, version 4.0. Results: The median age at diagnosis was 1.7 years (range, 0.6–16.6) and most patients (69%) had rhabdomyosarcomas. Treatments included brachytherapy delivered in all patients, chemotherapy (88%), surgery (31%), and external beam radiotherapy (5%). At a median follow-up of 15.5 years, 41/42 patients were alive. A total of 160 late effects were identified in 32/42 (76%) patients: 72% G1–2, and 28% G3–4 (the mean number of all grade late effects per patient: 4 [median: 2.5; range, 0–16] and the mean number of G3–4 late effects per patient: 1[median: 0; range, 0–8]). The most common all grade late toxicities were gynecological (75/160; 47%) and G3–4 were urinary (24/45; 53%). Sixteen patients (38%) required surgical treatment of late complications. The 15-year actuarial incidence rate of G3–4 late effects was 51%. The total number of all grade and G3–4 late effects was significantly increased in patients treated before 1990 ( p = 0.005 and p = 0.008), when the cumulative dose was higher ( p = 0.03 and p = 0.02), when the maximal dose was delivered to the ovaries ( p = 0.002 and p = 0.04), and when the brachytherapy volume was larger ( p = 0.03 and p = 0.02). Quality of life was good or very good in 91% of patients who completed the surveys. Conclusion: Long-term effects decreased with advances in treatment. Stringently controlled brachytherapy parameters should allow us to pursue improvements in order to prevent or minimize long-term sequelae.