Dose–effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study

Kirchheiner, Kathrin; Nout, Remi A.; Lindegaard, J.C.; Haie-Méder, Christine; Mahantshetty, Umesh; Šegedin, Barbara; Jürgenliemk-Schulz, Ina M.; Hoskin, Peter; Rai, Bhavana; Dörr, Wolfgang; Kirisits, Christian; Bentzen, Søren M.; Pötter, Richard; Tanderup, Kari

doi:10.1016/j.radonc.2015.12.025

Cited by 157 publications

(90 citation statements)

References 26 publications

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“…Grade 2 VS was defined as vaginal shortening/narrowing interfering with function and grade 3 as complete vaginal obliteration not surgically correctable, according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.011 as shown in Table 1. Grade 2 VS occurred in 29% of patients and grade ≥3 in 3.6%, with the majority occurring within 6 months 9. However, several small study series suggest that RT-induced VS may be less likely in the setting of adjuvant treatment for endometrial cancer using vaginal vault brachytherapy.…”

Section: Incidence Of Rt-induced Vsmentioning

confidence: 99%

“…In the setting of locally advanced cervical cancer, patients from the EMBRACE study were prospectively assessed to identify risk factors for VS. Factors identified were tumor extension into the vagina at diagnosis, plus an EBRT dose exceeding 45 Gy in 25 fractions and total EBRT and brachytherapy rectovaginal reference point dose 9. Similarly, in women treated with image-guided brachytherapy alone for cervical or endometrial cancer, vaginal dose and volume were also associated with an increased risk of VS 26,27.…”

Section: Risk Factorsmentioning

confidence: 99%

“…The incidence seems to be highest in women undergoing definitive treatment for locally advanced cervical cancer 9,10. Recent data from the multicenter international EMBRACE trial demonstrated that VS was the most frequently observed vaginal toxicity in women undergoing definitive chemoradiation and brachytherapy.…”

Section: Incidence Of Rt-induced Vsmentioning

confidence: 99%

“…Increasing dose and volume of vagina treated is associated with all grades of VS 9,14,26,27. In the setting of locally advanced cervical cancer, patients from the EMBRACE study were prospectively assessed to identify risk factors for VS. Factors identified were tumor extension into the vagina at diagnosis, plus an EBRT dose exceeding 45 Gy in 25 fractions and total EBRT and brachytherapy rectovaginal reference point dose 9.…”

Section: Risk Factorsmentioning

confidence: 99%

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Radiation-induced vaginal stenosis: current perspectives

Morris¹,

Do²,

Chard³

et al. 2017

IJWH

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Treatment of gynecological cancer commonly involves pelvic radiation therapy (RT) and/or brachytherapy. A commonly observed side effect of such treatment is radiation-induced vaginal stenosis (VS). This review analyzed the incidence, pathogenesis, clinical manifestation(s) and assessment and grading of radiation-induced VS. In addition, risk factors, prevention and treatment options and follow-up schedules are also discussed. The limited available literature on many of these aspects suggests that additional studies are required to more precisely determine the best management strategy of this prevalent group after RT.

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Section: Incidence Of Rt-induced Vsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Incidence Of Rt-induced Vsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Radiation-induced vaginal stenosis: current perspectives

Morris¹,

Do²,

Chard³

et al. 2017

IJWH

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show abstract

“…This is probably because dose distributions could be planned more conformal and surface doses at the vaginal wall were lower. Kirchheiner et al reported that a higher dose to the ICRU rectovaginal point and vaginal tumor invasion were risk factors for vaginal morbidity in the EMBRACE study 29. However, a sexual rehabilitation program was implemented in our department around the same time as combined intracavitary-interstitial brachytherapy was introduced, which may have lowered the risk of vaginal morbidity as well.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

Horeweg

Creutzberg

Rijkmans

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo evaluate the efficacy and toxicity of primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer and to identify predictors of treatment failure and toxicity.MethodsRetrospective analysis of 155 stage IB-IVA cervical cancer patients treated from 2008 to 2016 with chemoradiation and image-guided adaptive brachytherapy. Treatment consisted of external beam radiotherapy (45 – 48.6 Gy in 1.8 – 2 Gy fractions) with concurrent weekly cisplatin (40 mg/m2, 5 – 6 cycles) and image-guided adaptive brachytherapy (3−4 × 7 Gy high dose rate) using intracavitary or combined intracavitary-interstitial techniques according to GEC-ESTRO (Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology) recommendations. Incidences of all outcomes were calculated using Kaplan-Meier’s methodology. Risk factors for treatment failure and toxicity were identified using Cox’s proportional hazards model and the Kruskal-Wallis H-test respectively.ResultsMedian follow-up was 57 months. Five-year local control was 90.4 %. Five-year para-aortic lymph node metastasis-free and distant metastasis-free survival were 85.3 % and 70.2 % respectively. Tumor size and lymph node metastasis were independent risk factors for treatment failure. Cumulative incidences of severe late bladder, rectal, bowel, and vaginal toxicity were 0.8%, 3.3%, 3.6%, and 1.4% respectively at 5 years of follow-up. Combined intracavitary-interstitial brachytherapy techniques were associated with less vaginal morbidity.ConclusionsPrimary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer is a highly effective local and loco-regional treatment. However, survival is compromised by the occurrence of distant metastasis. Patients with large tumors and nodal involvement at diagnosis are at increased risk and may benefit from intensified treatment. Severe late gastrointestinal and urogenital toxicity is limited and may be further reduced by increasing conformity, using combined intracavitary-interstitial techniques and lowering doses to organs at risk.

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The physical and psychological sexual well‐being of women with pelvic malignancy: how can we understand and improve our practice?

Morris

Tharmalingam

2020

J of Medical Radiation Sci

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How can we better understand and improve our practice around the physical and psychological well‐being of women treated with radiation therapy for pelvic malignancy? In this issue, Summerfield et al report the results of a nationwide survey capturing practices around the management of radiation therapy‐induced vaginal adhesions and stenosis (RTVAS) across New Zealand. This study highlights the need for oncologists to improve care around a challenging but critically important aspect of women’s health beyond a cancer diagnosis.

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Dose–effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study

Cited by 157 publications

References 26 publications

Radiation-induced vaginal stenosis: current perspectives

Radiation-induced vaginal stenosis: current perspectives

Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

The physical and psychological sexual well‐being of women with pelvic malignancy: how can we understand and improve our practice?

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