Late rectal complication following high dose rate intracavitary brachytherapy in cancer of the cervix

Ogino, Ichiro; Kitamura, T.; Okamoto, Naoyuki; Yamasita, Kousuke; Aikawa, Yosihiro; Okajima, Hiroyuki; Matsubara, Sho

doi:10.1016/0360-3016(94)00547-8

Cited by 101 publications

(63 citation statements)

References 22 publications

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“…Clark et al 32 reported that the BED at the rectal reference point was correlated significantly with the incidence of late rectal complications, and they found a threshold of 125 Gy 3 at the rectal reference point for severe complication. Ogino et al 33 demonstrated that the calculated incidence of major rectal complications ranged from 5-10% at BED from 119 to 146 Gy 3. The BED at the rectum and bladder in our treatment ranged from 59 -133 Gy 3 (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Long‐term results of high‐dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix

Nakano

Kato

Ohno³

et al. 2004

Cancer

146

100

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BACKGROUNDThe authors performed a long‐term follow‐up study to evaluate the efficacy and late toxicity of high‐dose rate intracavitary brachytherapy (HDR‐ICBT) for cervical carcinoma.METHODSFrom 1968 to 1986, 1148 patients with Stage IB to IVB squamous cell carcinoma of the cervix (staging was performed according to the International Federation of Gynecology and Obstetrics) were treated with a combination of external beam radiotherapy (EBRT) and HDR‐ICBT. For patients with early‐stage disease, 20 gray (Gy) of EBRT was delivered to the whole pelvis, followed by 24 Gy/4 fractions of HDR‐ICBT and 30 Gy of central‐shielding EBRT. For patients with advanced‐stage disease, 20–40 Gy of whole pelvic EBRT was administered, followed by 24 Gy/4 fractions of ICBT and 30–10 Gy of central‐shielding EBRT. The overall treatment time was approximately 6 weeks. Among survivors, the follow‐up rate was 98% and the median follow‐up duration was 22 years.RESULTSThe 10‐year pelvic tumor control rates were 93% for patients with Stage IB disease, 82% for patients with Stage II disease, and 75% for patients with Stage III disease. The 10‐year overall and cause‐specific survival rates were 74% and 89% for patients with Stage IB disease, 52% and 74% for patients with Stage II disease, and 42% and 59% for patients with Stage III disease, respectively. The 10‐year actuarial rates of major complications were 4.4% in the rectosigmoid colon, 0.9% in the bladder, and 3.3% in the small intestines.CONCLUSIONSThe results of the current study suggest that the combination of EBRT and HDR‐ICBT according to the authors' protocol provided outcomes that were comparable to those of the conventional low‐dose rate brachytherapy with acceptable rates of late complications in the treatment of cervical carcinoma. Cancer 2005. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Long‐term results of high‐dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix

Nakano

Kato

Ohno³

et al. 2004

Cancer

146

100

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“…They demonstrated a strong correlation between the risk of LRC Ն Grade 3 and a BED RP Ͼ 125 Gy 3 . Ogino and coworkers 16 also reported a positive correlation between the risk of LRC (all grades) and BED RP ; LRC was observed in 0% of patients who received a BED RP Ͻ 100 Gy 3 , in 14% of patients who received 100 -120 Gy 3 , in 44% of patients who received 120 -140 Gy 3 , and in 72% of patients who received 140 Gy 3 . Contrary to these findings, Ferrigno et al 22 and Kapp et al 3 reported that BED RP was not correlated with LRC.…”

Section: Discussionmentioning

confidence: 88%

“…Several investigators [13][14][15][16][17]31 have sought to establish a correlation between LRC and the total BED RP . Conceptually, both EBRT and HDR-ICR can result in LRC in patients with cervical carcinoma; thus, the cumulative rectal dose potentially is more valuable for predicting the risk of LRC than other dosimetric parameters (EBRT dose, RP ratio, MP ratio, fraction size of ICR).…”

Section: Discussionmentioning

confidence: 99%

“…The following equation 19 was used to calculate the total BED: BED ϭ total dose ϫ [1 ϩ dose of fraction/(␣/␤)]; and total BED ϭ BED EBRT ϩ BED HDR-ICR , 15,16,20 where an ␣/␤ value of 3 was used for late responding tissues. Based on this equation, BED Point A ranged from 111.…”

Section: Treatmentmentioning

confidence: 99%

“…Several investigators [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] previously demonstrated that various clinical and treatment-related parameters, including age, diabetes mellitus, disease stage, EBRT dose, fractionation of brachytherapy, Point A dose, and rectal dose, were correlated with late rectal complications (LRC). In particular, RT dose and volume are considered the most important parameters associated with LRC.…”

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confidence: 99%

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Dosimetric parameters that predict late rectal complications after curative radiotherapy in patients with uterine cervical carcinoma

Kim

Choi

Park

et al. 2005

Cancer

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Expertise‐seeking research studies how people search for expertise and choose whom to contact in the context of a specific task. An important outcome are models that identify factors that influence expert finding. Expertise retrieval addresses the same problem, expert finding, but from a system‐centered perspective. The main focus has been on developing content‐based algorithms similar to document search. These algorithms identify matching experts primarily on the basis of the textual content of documents with which experts are associated. Other factors, such as the ones identified by expertise‐seeking models, are rarely taken into account. In this article, we extend content‐based expert‐finding approaches with contextual factors that have been found to influence human expert finding. We focus on a task of science communicators in a knowledge‐intensive environment, the task of finding similar experts, given an example expert. Our approach combines expertise‐seeking and retrieval research. First, we conduct a user study to identify contextual factors that may play a role in the studied task and environment. Then, we design expert retrieval models to capture these factors. We combine these with content‐based retrieval models and evaluate them in a retrieval experiment. Our main finding is that while content‐based features are the most important, human participants also take contextual factors into account, such as media experience and organizational structure. We develop two principled ways of modeling the identified factors and integrate them with content‐based retrieval models. Our experiments show that models combining content‐based and contextual factors can significantly outperform existing content‐based models.

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Biologically effective doses in medium dose rate brachytherapy of cancer of the cervix

Leborgne

Fowler

Leborgne

et al. 1997

Radiat. Oncol. Investig.

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The amount of dose reduction on changing from low dose rate (LDR) brachytherapy to medium dose rate (MDR) or high dose rate (HDR) afterloading has been the subject of much debate. The magnitude of reduction depends, together with other possible factors, on two radiobiological parameters: the α/β ratio and the half‐time of repair of the relevant tissues. In an attempt to extract these radiobiological parameters for the late rectal complications observed in our previously published clinical results four different schedules using MDR and one using LDR are analyzed. The percentage incidence of complications was a function of increasing biologically effective dose (BED), but would yield nonsense scattergrams if plotted against raw total dose. In addition, for three other published MDR series, three LDR series, and two HDR series, the incidence of rectal complications is plotted against BED to examine the predictive potential of using BED as the surrogate of total dose. Our own results were published in 1996, consisting of 102 patients treated at the LDR of 0.44 Gy/hr and 88 patients treated by four different schedules using an MDR of 1.6–1.7 Gy/hr. Follow‐up is at least 3 years in all schedules. The linear quadratic formula including the “g” dose rate factor was used to analyze them, assuming exponential repair of the repairable beta term. First, multivariate and profile‐likelihood analyses were carried out to obtain estimates of α/β and T½ for rectal late‐responding tissues. Then graphs of incidence of rectal complications vs. BED were constructed, assuming α/β = 3 Gy and T½ = 1.5 hr, values which had not been contradicted by the multivariate analysis. Graphs were drawn both for “all grades including mild reactions” (grades 1 + 2 + 3) and for “serious” complications (grade 3 in our system). In addition, other published cervical brachytherapy series were reviewed, with calculation of their BEDs if not published by the authors. It was necessary to review and compare their grading systems, so that “mild and moderate” (grades 1 and 2) could be contrasted with “serious” (grades 3 and 4 or 5 in various systems). Comparisons were made with other published results, including three LDR, three MDR, and two HDR series spanning from 1982 to 1997. The BEDs at which the incidence of rectal complications rose above the arbitrary level of 10% were compared for all three ranges of dose rate. The multivariate analysis gave estimates of α/β and T½ which were not significantly different from 3 Gy and 1.5 hr, respectively, so these values were used to compute the BEDs for the subsequent comparisons. It was found that the graphs of incidence of rectal complications for “all grades including mild” agreed rather better between all series than might have been expected, within a provisional (10%) threshold BED of range 100–123 Gy3 (60–74 Gy given as 2 Gy fractionated external beam or as LDR). The dose‐response curves diverged above these values, as expected until common grading systems such as SOMA/LENT become more widely used. For “...

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Late rectal complication following high dose rate intracavitary brachytherapy in cancer of the cervix

Cited by 101 publications

References 22 publications

Long‐term results of high‐dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix

Long‐term results of high‐dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix

Dosimetric parameters that predict late rectal complications after curative radiotherapy in patients with uterine cervical carcinoma

Biologically effective doses in medium dose rate brachytherapy of cancer of the cervix

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