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Clinical Trial
. 2019 Dec 16;19(1):1219.
doi: 10.1186/s12885-019-6423-5.

Vaginal dose of radical radiotherapy for cervical cancer in China: a multicenter study

Juan Wang  1 , Kai-Shuo Zhang  1 , Tao Wang  1 , Zi Liu  2 , Rui-Hua Wang  1 , Fu-Quan Zhang  3 , Lang Yu  3 , Li Ran  4 , Jian-Li He  5 , Ya-Li Wang  6 , Li-Chun Wei  7 , Mei Shi  7 , Guo-Qing Wang  8 , Chao-Qun Wu  9 , Qi-Jun Kang  9 , Jie Yang  10 , Sha Li  11 , Fei-Yue Yang  12 , Bao-Gang Liu  13 , Juan-Yue Liu  14 , Fan Shi  1 , Jin Su  1 , Wei Yuan  1 , Emmanuel Kwateng Drokow  1
Affiliations
Clinical Trial

Vaginal dose of radical radiotherapy for cervical cancer in China: a multicenter study

Juan Wang et al. BMC Cancer. .

Abstract

Background: The posterior-inferior border of symphysis (PIBS) point system is a novel vaginal dose-reporting method and is a simple and reliable method proposed by the Medical University of Vienna proposed for both external-beam radiotherapy (EBRT) and brachytherapy (BT). In this multicenter study, we sought to first evaluate the vaginal radiation dose in Chinese cervical cancer patients according to the PIBS point system and then to analyze the factors influencing the dose distribution.

Methods: We collected data from the medical records of 936 cervical cancer patients who underwent concurrent radiochemotherapy at 13 different institutions in China. Radiation doses at points A, PIBS+ 2 cm, PIBS and PIBS-2 cm, International Commission on Radiation Units (ICRU)-R and ICRU-B were measured.

Results: The median total doses in EQD2α/β = 3 at points PIBS+ 2 cm, PIBS and PIBS-2 cm were 82.5 (52.7-392.1) Gy, 56.2 (51.4-82.1) Gy and 2.6 (0.9-7.4) Gy, respectively. The median total doses in EQD2α/β = 3 at ICRU-R and ICRU-B were 77.5 (54.8-132.4) Gy and 79.9 (60.7-133.7) Gy, respectively. The mean vaginal reference length (VRL) was 4.6 ± 1.0 cm (median, 4.5 cm). In patients with VRL ≤4.5 cm, the mean total doses in EQD2α/β = 3 at points PIBS+ 2 cm, PIBS and PIBS-2 cm were 128.5, 60.7 and 0.8 Gy, respectively. In patients with VRL > 4.5 cm, the mean total doses at these three points were 68.9, 0.5 and 54.5 Gy, respectively. Classification of patients revealed significant differences (P < 0.05) between these two groups.

Conclusions: With the PIBS point system, Chinese patients with a shorter VRL of < 4.5 cm received higher radiation doses at the PIBS+ 2 cm, PIBS and PIBS-2 cm points than European and American patients. Further studies are required to establish the dose-effect relationships with these points as references. The study was registered as a clinical trial (NCT03257475) on August 22, 2017.

Keywords: Cervical cancer; PIBS; Radiotherapy; Vaginal dose.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Scatter diagram showing that the doses at PIBS points varied with the VRL. The dose at the PIBS+ 2 cm point changed steeply, while the dose at PIBS-2 cm changed only slightly with increasing VRL. The change in the PIBS dose was moderate
Fig. 2
Fig. 2
BT CT sagittal view for a patient with tandem and ovoid applicator. The picture shows three cases of BT planning for three patients with different VRLs. a: Patient with a VRL of 6.8 cm. b: Patient with a median VRL of 4.5 cm. c: Patient with a VRL of 3.5 cm, in whom the PIBS+ 2 cm point was located in the high dose area. Red contour: the 150% isodose line. Green contour: the 100% isodose line. Red dashes: level of PIBS points. Yellow dot: PIBS+ 2 cm point. With a shorter VRL, the PIBS+ 2 cm point becomes closer to the vaginal applicator. Definition of the PIBS+ 2 cm is not applicable anymore
See this image and copyright information in PMC

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