Dose volume parameter D2cc does not correlate with vaginal side effects in individual patients with cervical cancer treated within a defined treatment protocol with very high brachytherapy doses

Fidarova, Elena; Berger, Daniel; Schüssler, Sandra; Dimopoulos, Johannes; Kirisits, Christian; Georg, Petra; Bachtiary, Barbara; Pötter, Richard

doi:10.1016/j.radonc.2010.05.005

Cited by 52 publications

(13 citation statements)

References 20 publications

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“…They reported that D 2cc for the rectum was a reliable predictor of late rectal complication; however because of limited number of events it was not able to explore the DHV parameters for vaginal complication [5]. Recently, Vienna group tried to find out DVH parameters that correlate with vaginal late morbidities but vaginal D 2cc did not relate with the vaginal morbidities [12]. The calculation method was the same as the current study, which was composed of EBRT and ICBT/ISBT and normalized to 2 Gy per fraction (EQD 2 ) using the linear-quadratic model with α/β of 3 Gy for the vaginal morbidities [10-12,16].…”

Section: Discussionmentioning

confidence: 99%

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Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies

et al. 2014

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BackgroundPurpose of this study was to identify predictors of vaginal ulcer after CT based three-dimensional image-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for gynecologic malignancies.MethodsRecords were reviewed for 44 female (14 with primary disease and 30 with recurrence) with gynecological malignancies treated with HDR-ISBT with or without external beam radiation therapy. The HDR-ISBT applicator insertion was performed with image guidance by trans-rectal ultrasound and CT.ResultsThe median clinical target volume was 35.5 ml (2.4-142.1 ml) and the median delivered dose in equivalent dose in 2 Gy fractions (EQD2) for target volume D90 was 67.7 Gy (48.8-94.2 Gy, doses of external-beam radiation therapy and brachytherapy were combined). For re-irradiation patients, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 91.1 Gy, 100.9 Gy, 260.3 Gy, 212.3 Gy, 170.1 Gy, 117.1 Gy, 105.2 Gy, and 94.7 Gy, respectively. For those without prior radiation therapy, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 56.3 Gy, 54.3 Gy, 147.4 Gy, 126.2 Gy, 108.0 Gy, 103.5 Gy, 94.7 Gy, and 80.7 Gy, respectively. Among five patients with vaginal ulcer, three had prior pelvic radiation therapy in their initial treatment and three consequently suffered from fistula formation. On univariate analysis, re-irradiation and vaginal wall D2cc in EQD2 was the clinical predictors of vaginal ulcer (p = 0.035 and p = 0.025, respectively). The ROC analysis revealed that vaginal wall D2cc is the best predictor of vaginal ulcer. The 2-year incidence rates of vaginal ulcer in the patients with vaginal wall D2cc in EQD2 equal to or less than 145 Gy and over 145 Gy were 3.7% and 23.5%, respectively, with a statistically significant difference (p = 0.026).ConclusionsRe-irradiation and vaginal D2cc is a significant predictor of vaginal ulcer after HDR-ISBT for gynecologic malignancies. Three-dimensional image-guided treatment planning should be performed to ensure adequate target coverage while minimizing vaginal D2cc in order to avoid vagina ulcer.

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Section: Discussionmentioning

confidence: 99%

“…Vaginal wall was extracted with a thickness of 4 mm on all CT images according to the Vienna group [12]. As for rectum and bladder, dosimetric parameter of D 2cc was used because these values have been validated by several studies [6-8].…”

Section: Methodsmentioning

confidence: 99%

Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies

et al. 2014

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“…They found no association with the dose volume parameters and vaginal toxicity. The reasons can be due to difficulty in assessing the dose to the vagina as high variations in the contouring and geometric positioning that have been reported using both point dose values and DVH parameters for the vaginal wall [9] [20] [21].…”

Section: Discussionmentioning

confidence: 99%

“…However, recent publications by Gondi et al showed higher incidence of late vaginal toxicity in chemoradiation group [8]. Limited reported data onto vaginal effects of image-guided brachytherapy in volume and point approaches are available [9].…”

Section: Introductionmentioning

confidence: 99%

The Associations for Vaginal Point Doses of Vaginal Stenosis in Image-Guided Brachytherapy

Tharavichitkul¹,

Jayavasti²,

Galalae³

et al. 2014

JCT

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“…These adaptive, conformal BT approaches have resulted in significantly improved clinical outcomes 12. Volumetric OAR dose constraints, such as the minimal dose of the 2 cc of normal tissue with the highest dose (D2cc) or D0.1 cc, have been investigated13, 14, 15 as an alternative to conventional rectum and bladder point doses. These alternatives originated from the ICRU Report #38,16 and are mainly applicable to Point A‐based BT planning techniques.…”

Section: Introductionmentioning

confidence: 99%

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Gelover

Katherine

Mart

et al. 2018

J Applied Clin Med Phys

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The objective of this study was to assess the recommended DVH parameter (e.g., D2 cc) addition method used for combining EBRT and HDR plans, against a reference dataset generated from an EQD2‐based DVH addition method. A revised DVH parameter addition method using EBRT DVH parameters derived from each patient's plan was proposed and also compared with the reference dataset. Thirty‐one biopsy‐proven cervical cancer patients who received EBRT and HDR brachytherapy were retrospectively analyzed. A parametrial and/or paraaortic EBRT boost were clinically performed on 13 patients. Ten IMRT and 21 3DCRT plans were determined. Two different HDR techniques for each HDR plan were analyzed. Overall D2 cc and D0.1 cc OAR doses in EQD2 were statistically analyzed for three different DVH parameter addition methods: a currently recommended method, a proposed revised method, and a reference DVH addition method. The overall D2 ccEQD 2 values for all rectum, bladder, and sigmoid for a conformal, volume optimization HDR plan generated using the current DVH parameter addition method were significantly underestimated on average −5 to −8% when compared to the values obtained from the reference DVH addition technique (P < 0.01). The revised DVH parameter addition method did not present statistical differences with the reference technique (P > 0.099). When PM boosts were considered, there was an even greater average underestimation of −8~−10% for overall OAR doses of conformal HDR plans when using the current DVH parameter addition technique as compared to the revised DVH parameter addition. No statistically significant differences were found between the 3DCRT and IMRT techniques (P > 0.3148). It is recommended that the overall D2 cc EBRT doses are obtained from each patient's EBRT plan.

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Dose volume parameter D2cc does not correlate with vaginal side effects in individual patients with cervical cancer treated within a defined treatment protocol with very high brachytherapy doses

Cited by 52 publications

References 20 publications

Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies

Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies

The Associations for Vaginal Point Doses of Vaginal Stenosis in Image-Guided Brachytherapy

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

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