Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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
Affiliations

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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Nout R.A., Smit V.T., Putter H. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomized trial. Lancet. 2010;375:816–823. - PubMed
    1. Nout R.A., Putter H., Jurgenliemk-Schulz I.M. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009;27:3547–3556. - PubMed
    1. Sorbe B., Nordström B., Mäenpää J. Intravaginal brachy-therapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer. 2009;19:873–878. - PubMed
    1. Choo J.J., Scudiere J., Bitterman P., Dickler A., Gown A.M., Zusag T.W. Vaginal lymphatic channel location and its implication for intracavitary brachytherapy radiation treatment. Brachytherapy. 2005;4(3):236–240. - PubMed
    1. Guinot J.L., Perez-Calatayud J., Azcoaga J.M. Consensus on treatment of endometrium carcinoma with brachytherapy. Clin Transl Oncol. 2012;14:263–270. - PubMed