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. 2020 Mar-Apr;25(2):227-232.
doi: 10.1016/j.rpor.2020.01.002. Epub 2020 Jan 14.

Postoperative endometrial carcinoma treated with external beam irradiation plus vaginal-cuff brachytherapy. Is there a dose relationship with G2 vaginal complications?

Yaowen Zhang  1   2 , Carlos Ascaso  1 , Antonio Herreros  1   2 , Joan Sánchez  3 , Sebastia Sabater  4 , Marta Del Pino  5 , Yan Li  1   2 , Gabriela Gómez  2   6 , Aureli Torné  5 , Albert Biete  1   2   5 , Ángeles Rovirosa  1   2   5
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Postoperative endometrial carcinoma treated with external beam irradiation plus vaginal-cuff brachytherapy. Is there a dose relationship with G2 vaginal complications?

Yaowen Zhang et al. Rep Pract Oncol Radiother. 2020 Mar-Apr.

Abstract

Aim: To analyse the possible relationship between the EQD2(α/β=3Gy) at 2 cm3 of the vagina and late toxicity in vaginal-cuff-brachytherapy (VBT) after external-beam-irradiation (EBRT) for postoperative endometrial carcinoma (EC).

Materials and methods: From 2014 to 2016, 62 postoperative EC patients were treated with EBRT + VBT. The median EBRT dose was 45 Gy (44 Gy-50.4 Gy). VBT involved a single 7 Gy dose. Toxicity was prospectively evaluated using the RTOG score for the rectum and bladder and the objective LENT-SOMA criteria for the vagina. EQD2(α/β = 3Gy) at 2 cm3 of the most exposed part of the vagina was calculated by the sum of the EBRT + VBT dose. Statistics: Boxplot, Student's t and Chi-square tests and ROC curves.

Results: Mean follow-up: 39.2 months (15-68). Late toxicity: bladder:0 patient; rectum:2 patients-G1; Vagina: 26 patients-17G1, 9G2; median EQD2(α/β=3Gy) at 2 cm3 in G0-G1 patients was 70.4 Gy(SD2.36), being 72.5 Gy(SD2.94) for G2p. The boxplot suggested a cut-point identifying the absence of G2: 100 % of G2p received >68 Gy, ROC curves showed an area under the curve of 0.72 (sensitivity of 1 and specificity of 0.15).

Conclusions: Doses >68 Gy EQD2(α/β=3Gy) at 2 cm3 to the most exposed area of the vagina were associated with late G2 vaginal toxicity in postoperative EC patients treated with EBRT + VBT suggesting a very good dose limit to eliminate the risk of G2 late toxicity. The specificity obtained indicates the need for prospective analyses.

Keywords: Brachytherapy; Late vaginal toxicity; Postoperative endometrial cancer.

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Figures

Fig. 1
Fig. 1
Overall survival at 2 and 5 years.
Fig. 2
Fig. 2
EQD2(α/β=3Gy) at 2 cm3 of vagina and G0-G1 vs.G2 vaginal toxicity.
Fig. 3
Fig. 3
ROC Curve 68 Gy had a sensitivity of 1 and a specificity of 0.15.
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