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. 2023 Apr;34(4):929-935.
doi: 10.1007/s00192-022-05363-7. Epub 2022 Oct 1.

An assessment of urethral radiation exposure in the treatment of endometrial and rectal cancers

Katherine Hines  1 , Karina Nieto  2 , William Dezarn  2 , Kathryn Greven  2 , Bridget Krol  3 , Catherine Matthews  1 , Candace Parker-Autry  4
Affiliations

An assessment of urethral radiation exposure in the treatment of endometrial and rectal cancers

Katherine Hines et al. Int Urogynecol J. 2023 Apr.

Abstract

Introduction and hypothesis: Female survivors of endometrial and rectal cancers have increased risk of urinary incontinence. Survivors with prior radiation therapy are counseled against mesh incontinence surgery. We hypothesize that urethral radiation dose varies based on modality which may influence surgical risks. We aimed to demonstrate urethral radiation dose differences between vaginal brachytherapy (VBT) and external beam radiation therapy (EBRT).

Methods: This is a retrospective cohort study of women exposed to VBT for endometrial cancer and EBRT for rectal cancer. The urethra was contoured on CT imaging to calculate radiation doses in centigray (cGy). The primary outcome was the percent of treatment radiation dose estimated to be received by the urethra based on the volume dose to 0.2 cc of urethra. Secondary outcomes were point doses to the bladder neck, mid-urethra, and total mean urethral dose. Descriptive statistics described demographic characteristics. Bivariate analyses compared urethral radiation dose based on radiation modality.

Results: Between 2014-2017, 32 women treated were included: 18 with VBT and 14 with EBRT. Mean ± SD urethral volume doses were lower in VBT (1266 cGy ± 533, 42.2% of prescribed treatment dose) compared to EBRT (5051 cGy ± 192, 100.2% of prescribed treatment dose), p < 0.0001. VBT also had significantly lower mean total urethral dose and point doses to bladder neck and mid- urethra compared to EBRT (p < 0.0001).

Conclusions: The female urethra is exposed to significantly less radiation in VBT compared to EBRT. These data highlight that modality of pelvic radiation should be considered in treatment counseling on urinary incontinence in women.

Keywords: Endometrial cancer; Incontinence; Mesh slings; Radiation therapy; Rectal cancer.

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Figures

Fig. 1
Fig. 1
Schema of contoured urethral volumes
Fig. 2
Fig. 2
A coronal image of external beam radiation therapy treatment planning with radiation doses depicted by color. The contoured urethra is surrounded by a black box
Fig. 3
Fig. 3
A sagittal view of treatment planning CT with vaginal brachytherapy in place. The contoured urethra is surrounded by a black box
Fig. 4
Fig. 4
A graphical representation of calculated urethral radiation doses. Standard deviations are represented by brackets
See this image and copyright information in PMC

Comment in

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