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. 2022 Apr 19:12:840144.
doi: 10.3389/fonc.2022.840144. eCollection 2022.

Using New Vaginal Doses Evaluation System to Assess the Dose-Effect Relationship for Vaginal Stenosis After Definitive Radio(Chemo)Therapy for Cervical Cancer

Juan Wang  1 , Kai-Shuo Zhang  2 , Zi Liu  1 , Tao Wang  1 , Rui-Hua Wang  1 , Fu-Quan Zhang  3 , Lang Yu  3 , Ya-Li Wang  4 , Li-Chun Wei  5 , Mei Shi  5 , Sha Li  6 , Bao-Gang Liu  7 , Fan Shi  1 , Jin Su  1 , Wei Yuan  1 , Qi Ying Zhang  1 , Jing Zhang  1
Affiliations

Using New Vaginal Doses Evaluation System to Assess the Dose-Effect Relationship for Vaginal Stenosis After Definitive Radio(Chemo)Therapy for Cervical Cancer

Juan Wang et al. Front Oncol. .

Abstract

Objective: The study aims to investigate if a relationship exists between vaginal doses and vaginal stenosis (VS) using posterior-inferior border of symphysis (PIBS) points and the International Commission on Radiation Units-Rectum (ICRU-R) point evaluation system for definitive radio(chemo)therapy in locally advanced cervical cancer.

Methods and materials: From a vaginal dose study in China, 351 patients were prospectively assessed. For every reference point of the PIBS system and ICRU-R point was calculated for all BT and summed with EBRT. Pearson's chi-square test and Student's unpaired t-test compared variables with and without vaginal stenosis (VS) G ≥2. The risk factors were assessed for VS G ≥2 in multi- and univariate analyses through Cox proportional hazards model followed by a dose-effect curve construction. The VS morbidity rate was compared via the log-rank test using the median vaginal reference length (VRL).

Results: The patients (38-month median follow-up) had 21.3% three-year actuarial estimate for VS G ≥2. Compared to G <2 patients, VS G ≥2 patients received higher doses to PIBS points except for PIBS - 2 and had significantly shorter VRL. VRL (HR = 1.765, P = 0.038), total EBRT and BT ICRU-R point dose (HR = 1.017, p = 0.003) were risk factors for VS. With VRL >4.6 cm, the 3-year actuarial estimate was 12.8% vs. 29.6% for VRL ≤4.6 cm. According to the model curve, the risks were 21, 30, and 39% at 75, 85, and 95 Gy, respectively (ICRU-R point dose).

Conclusions: PIBS system point doses correlated with late vaginal toxicity. VRL combined with both EBRT and BT dose to the ICRU-R point contribute to VS risk.

Keywords: ICRU rectum point; PIBS points system; cervical cancer; radiotherapy; vaginal stenosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence for vaginal stenosis G ≥2.
Figure 2
Figure 2
Actuarial estimates for VS G ≥2 in patients VRL ≤4.6 cm in comparison to those with VRL >4.6 cm.
Figure 3
Figure 3
The relationship of dose–effect of the combined brachytherapy and EBRT dose to ICRU-R point in EQD2 and VS G≥2 in (N = 351) patients. Three black points represent ICRU-R point doses of 75, 85, and 95 Gy, respectively.
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