open access

Vol 25, No 2 (2020)
Original research articles
Published online: 2020-03-01
Submitted: 2019-10-31
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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, Carlos Ascaso, Antonio Herreros, Joan Sánchez, Sebastia Sabater, Marta del Pino, Yan Li, Gabriela Gómez, Aureli Torné, Albert Biete, Ángeles Rovirosa
DOI: 10.1016/j.rpor.2020.01.002
·
Rep Pract Oncol Radiother 2020;25(2):227-232.

open access

Vol 25, No 2 (2020)
Original research articles
Published online: 2020-03-01
Submitted: 2019-10-31

Abstract

Aim

To analyse the possible relationship between the EQD2(α/β=3Gy) at 2cm3 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 45Gy (44Gy–50.4Gy). VBT involved a single 7Gy 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 2cm3 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 2cm3 in G0-G1 patients was 70.4Gy(SD2.36), being 72.5Gy(SD2.94) for G2p. The boxplot suggested a cut-point identifying the absence of G2: 100 % of G2p received >68Gy, ROC curves showed an area under the curve of 0.72 (sensitivity of 1 and specificity of 0.15).

Conclusions

Doses >68Gy EQD2(α/β=3Gy) at 2cm3 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.

Abstract

Aim

To analyse the possible relationship between the EQD2(α/β=3Gy) at 2cm3 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 45Gy (44Gy–50.4Gy). VBT involved a single 7Gy 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 2cm3 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 2cm3 in G0-G1 patients was 70.4Gy(SD2.36), being 72.5Gy(SD2.94) for G2p. The boxplot suggested a cut-point identifying the absence of G2: 100 % of G2p received >68Gy, ROC curves showed an area under the curve of 0.72 (sensitivity of 1 and specificity of 0.15).

Conclusions

Doses >68Gy EQD2(α/β=3Gy) at 2cm3 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.

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Keywords

Postoperative endometrial cancer; Brachytherapy; Late vaginal toxicity

About this article
Title

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

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 2 (2020)

Pages

227-232

Published online

2020-03-01

DOI

10.1016/j.rpor.2020.01.002

Bibliographic record

Rep Pract Oncol Radiother 2020;25(2):227-232.

Keywords

Postoperative endometrial cancer
Brachytherapy
Late vaginal toxicity

Authors

Yaowen Zhang
Carlos Ascaso
Antonio Herreros
Joan Sánchez
Sebastia Sabater
Marta del Pino
Yan Li
Gabriela Gómez
Aureli Torné
Albert Biete
Ángeles Rovirosa

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