EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma

Zhang, Yaowen; Fornes, B.; Gomez, Gabriela B.; Bentoldrà, Irene; Carmona, C M Orejuela; Herreros, Antonio Garcı́a de; Sabater, S.; Nicolás, Inmaculada; Li, Yan; Sánchez, Javier; Biete, Albert; Torné, Aureli; Ascaso, Carlos; Rovirosa, Á.

doi:10.3390/cancers12103059

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…Hence, we hypothesized that considering the vagina as an OAR, EQD 2 cm 3 values of vagina could be designated as a predictor of vaginal toxicity. On analyzing the correlation of dose with toxicity in postoperative patients treated with HDR BT, we found that there was an association between EQD2 (α/β=3 Gy) at 2 cm 3 of vagina and G2 late vaginal toxicity [13][14][15]. A dose limit of 68 Gy EQD2 (α/β=3 Gy) at the most exposed 2 cm 3 of the vagina has been applied for reducing vaginal toxicity since 2016.…”

Section: Discussionmentioning

confidence: 99%

“…In patients receiving combined treatment, EQD2 (α/β=3 Gy) of EBRT was added to the EQD2 (α/β=3 Gy) VBT dose. The procedure of CTV definition and dose prescription has previously been reported [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…Three previous studies at Hospital Clinic of Barcelona reported that an EQD2 (α/β=3 Gy) > 68 Gy at 2 cm 3 was associated with vaginal toxicity ≥ G2 in 20% of patients [ 13 – 15 ]. The last 2 preliminary studies with 2 different schedules showed an incidence of G2+ late vaginal toxicity of 24.3% and 10.7% in the schedules of 1 fraction of 7 Gy after EBRT and 3 fractions of 6 Gy for exclusive VBT, respectively, and 18.6% and 4.8% for 2 fractions of 5–6 Gy after EBRT and 4 fractions for exclusive VBT, respectively, with a follow-up of 30 and 29.5 months, respectively [ 8 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: a prospective analysis

et al. 2021

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Purpose To evaluate the preliminary results of the use of 68 Gy EQD2(α/β=3 Gy) as a dose limit to the lowest dose in the most exposed 2 cm3 of the vagina in order to reduce G2 late vaginal problems in postoperative endometrial carcinoma (EC). Methods From November 2016 to October 2019, 69 postoperative EC patients receiving vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) were prospectively analyzed. The median EBRT dose was 45 Gy (range: 44–50.4 Gy), 1.8−2 Gy/day, 5 fractions(Fr)/week. VBT was administered with the following schedule: 1Fr of 7 Gy after EBRT and 2 daily Fr × 7.5 Gy in exclusive VBT. The dose was prescribed at 0.5 cm from the applicator surface with an active length of 2.5 cm; 56 patients were treated with vaginal cylinders (49–3.5 cm, 6–3 cm, and 1–2.5 cm) and 13 with the colpostat technique. The overall VBT dose was adjusted to meet the vaginal restriction of < 68 Gy EQD2(α/β=3 Gy) at 2 cm3. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum, and the objective LENT-SOMA criteria for vagina. Results With a median follow-up of 31.0 months, no vaginal-cuff recurrences were found. Late toxicity: only 1G1(1.4%) rectal toxicity; 21G1(30.4%) and 3G2(4.3%) vaginal complications. Only one (1.4%) of 3 G2 manifested as vaginal shortening. Conclusions In postoperative EC patients treated with VBT, only one developed G2 vaginal stenosis with the use of 68 Gy EQD2(α/β=3 Gy) as a dose constraint. These preliminary results seem to indicate the value of this dose limit for reducing G2 vaginal stenosis. Nonetheless, these findings should be confirmed in a larger number of patients with longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: a prospective analysis

et al. 2021

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“…Measuring inside an applicator instead of in organs at risk (OAR) offers the main and important advantage of greatly reducing the uncertainty of the PSD probe position because the movement of OAR does not affect the PSD signal measurement. The cylinder was inserted in the vagina in the operating room and secured with elastic bands as reported elsewhere by our group [ 20 , 21 ]. The CT images provide confirmation of good contact of the applicator with the vaginal-cuff and are also the image set for 3D treatment planning with the criteria of vaginal toxicity [ 21 , 22 , 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…The cylinder was inserted in the vagina in the operating room and secured with elastic bands as reported elsewhere by our group [ 20 , 21 ]. The CT images provide confirmation of good contact of the applicator with the vaginal-cuff and are also the image set for 3D treatment planning with the criteria of vaginal toxicity [ 21 , 22 , 23 , 24 ]. All the patients were treated with one of the following two schemes: (a) one session of 7 Gy after external brachytherapy or (b) two fractions of 7.5 Gy in exclusive brachytherapy.…”

Section: Methodsmentioning

confidence: 99%

In Vivo Verification of Treatment Source Dwell Times in Brachytherapy of Postoperative Endometrial Carcinoma: A Feasibility Study

Herreros

Pérez‐Calatayud

Ballester

et al. 2022

JPM

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(1) Background: In brachytherapy, there are still many manual procedures that can cause adverse events which can be detected with in vivo dosimetry systems. Plastic scintillator dosimeters (PSD) have interesting properties to achieve this objective such as real-time reading, linearity, repeatability, and small size to fit inside brachytherapy catheters. The purpose of this study was to evaluate the performance of a PSD in postoperative endometrial brachytherapy in terms of source dwell time accuracy. (2) Methods: Measurements were carried out in a PMMA phantom to characterise the PSD. Patient measurements in 121 dwell positions were analysed to obtain the differences between planned and measured dwell times. (3) Results: The repeatability test showed a relative standard deviation below 1% for the measured dwell times. The relative standard deviation of the PSD sensitivity with accumulated absorbed dose was lower than 1.2%. The equipment operated linearly in total counts with respect to absorbed dose and also in count rate versus absorbed dose rate. The mean (standard deviation) of the absolute differences between planned and measured dwell times in patient treatments was 0.0 (0.2) seconds. (4) Conclusions: The PSD system is useful as a quality assurance tool for brachytherapy treatments.

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Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?

et al. 2023

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Purpose Analyse the impact of different prognostic factors on G2-late vaginal complications after vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) in postoperative endometrial cancer (PEC). Methods One hundred and twenty-six PEC patients treated with VBT ± EBRT were retrospectively analysed considering age, body mass index, applicator diameter, clinical target volume (CTV), use of dilators, chemotherapy and EQD2(α/β=3) at the most exposed 2 cm3 of the CTV as prognostic factors for vaginal complications. Late vaginal complications were evaluated using objective LENT-SOMA criteria. Statistics: descriptive analysis, Chi-square, Fisher and Student tests were applied. Univariate and multivariate analyses were performed with the Baptista–Pike exact method and multiple logistic regression. Results Mean age was 65 years (SD ± 10), and median follow-up was 66 months (8–104). 19/126 patients (15%) showed G2-late vaginal complications, and 107/126 (85%) G0–G1. Univariate analysis showed: CTV ≤ 9 cm3 (p = 0.036), use of dilators < 9 months (p = 0.015), and total ≥ 68 Gy EQD2 received by 2 cm3 of CTV (p = 0.039) were associated with G2-late vaginal toxicity. Multivariate analysis showed the use of dilators < 9 months as an independent prognostic factor for G2-late vaginal toxicity (p = 0.043, OR 8.59, CI 1.59–159.9). Conclusion The use of dilators < 9 months in VBT ± EBRT for PEC was an independent prognostic factor for G2-late vaginal toxicity. The use of vaginal dilators ≥ 9 months requires further analysis in studies evaluating late vaginal toxicity.

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EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma

Cited by 8 publications

References 35 publications

Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: a prospective analysis

Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: a prospective analysis

In Vivo Verification of Treatment Source Dwell Times in Brachytherapy of Postoperative Endometrial Carcinoma: A Feasibility Study

Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?

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