Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients

The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies

“…These findings challenge the dogma that the vagina is a radio-resistant organ, and evidence-based dosimetric guidance can be introduced with the aim of reducing vaginal dose and morbidity [38] . New recommendations on vaginal dose reporting for the mid and low vagina may furthermore contribute to increased sparing of vaginal tissue from unnecessary irradiation [39] , [40] . Analysis of rectal morbidity in the EMBRACE I study demonstrated that G3 and G4 rectal morbidity is uncommon with IGABT [41] .…”

“…There are also currently large differences between institutions regarding the definition of the lower field border of EBRT [40] . An increased awareness of the lower EBRT target border through a well-defined target concept for EBRT, and a specific vaginal dose reporting system referring to the Posterior-Inferior Border of the Symphysis (PIBS) [39] , [40] , should reduce the EBRT dose to the lower and mid vagina.…”

Inter-observer and intra-observer variability in reporting vaginal dose points for cervical cancer in high-dose-rate brachytherapy

“…Determination of eight additional reference points for BT in the upper vagina from axial MRI were removed. However, there were relevant discrepancies not only between patients, as it has been previously reported [20,22], but also inter-and intra-observer discrepancies regarding the same patient. Moreover, intra-observer variations could be as large as inter-observer ones, when points are situated in a high gradient region.…”

“…In order to blind the observers, at least one-week gap was introduced between the two measurements. In order to do this, a common methodology was established based on the one described by other authors [20,22], but compromised regarding technical steps, which can provide ambiguous results, especially when adapting such a method to the Utrecht applicator used in our center.…”

“…The authors applied the method to a dataset of 62 patients treated with a combination of external radiotherapy EBRT (45 Gy in 25 fractions) and brachytherapy (7 Gy per fraction in 4 fractions) with a tandem-ring applicator. They also performed a multicenter and multi-applicator evaluation of 153 patients from 7 institutions, where different applicators, dose rates, and protocols were used, analyzing the robustness of their methodology between several centers and patients [22]. Large differences throughout the entire vagina were found between patients and between centers.…”