Vaginal dose assessment in image-guided brachytherapy for cervical cancer: Can we really rely on dose-point evaluation?

Limkin, Elaine Johanna; Dumas, Isabelle; Campo, Eleonor Rivin del; Chargari, Cyrus; Maroun, Pierre; Annède, Pierre; Petit, Claire; Seisen, Thomas; Doyeux, Kaya; Tailleur, Aurélie; Martinetti, F.; Lefkopoulos, Dimitri; Haie-Méder, Christine; Mazeron, R.

doi:10.1016/j.brachy.2015.11.005

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…D ICRU has been successfully used in 2D-based brachytherapy reporting and prescribing for long and specific constraints using such dose points have been widely used [20][21][22][23]. In a multivariate analysis within the EMBRACE cohort, the rectal D ICRU has been shown to be an independent predictor of vaginal stenosis, an area where quantitative dose-effect associations have been lacking so far [24]. These findings contributed to re-define the ICRU rectal point (ICRU 38) as ICRU recto-vaginal point (ICRU 89) [17,25].…”

Section: Discussionmentioning

confidence: 99%

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Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

Mazeron

Fokdal

Kirchheiner

et al. 2016

Radiotherapy and Oncology

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214

121

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Section: Discussionmentioning

confidence: 99%

“…Outcomes and morbidity were assessed at 3,6,9,12,18,24,30,36,48, and 60 months after treatment completion. Morbidity was evaluated using the Common Toxicity Criteria for adverse events (CTC-AE), version 3.0.…”

Section: Morbiditymentioning

confidence: 99%

Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

Mazeron

Fokdal

Kirchheiner

et al. 2016

Radiotherapy and Oncology

Self Cite

214

121

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“…The EMBRACE study did not find any relationship between vaginal toxicity and EQD2 dose at 2 cm 3 of vagina. Other studies by this group and others are currently ongoing to analyze and reduce vaginal toxicity in patients with cervical cancer [ 4 , 6 , 7 , 8 ].…”

Section: Purposementioning

confidence: 99%

Late G2 vagina toxicity in post-operative endometrial carcinoma is associated with a 68 Gy dose equivalent to 2 Gy per fraction (α/β=3Gy) at 2 cm 3 of vagina

Aguilera¹,

Rovirosa²,

Ascaso³

et al. 2018

jcb

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PurposeTo evaluate if the dose equivalent to 2 Gy per fraction (EQD2)(α/β=3Gy) at 0.1 cm3, 1 cm3, and 2 cm3 of vagina in vaginal-cuff-brachytherapy (VBT) (high-dose-rate [HDR] 192Ir-source) ± external-beam-irradiation (EBRT) is associated with toxicity in post-operative endometrial carcinoma (P-EC).Material and methodsFrom June 2014 till November 2015, 67 consecutive P-EC patients underwent VBT ± EBRT; 44 patients received EBRT (median, 45 Gy; range, 44-50.4) + VBT (7 Gy), and 23 exclusive-VBT (6 Gy x 3 fractions). The upper 2.5 cm of vagina was delineated on computed tomography (CT). The active-length source was 2.5 cm, and the brachytherapy dose was prescribed at 5 mm from the applicator. D90, V100, and EQD2(α/β=3Gy) at 0.1 cm3, 1 cm3, and 2 cm3 of the most exposed part of the vagina were calculated. Vaginal toxicity assessment was completed with a LENT-SOMA-objective-criteria. Statistics were done with the use of χ2 and Student’s-t test.ResultsThe mean follow-up was 23.2 months (7.6-46.8). Median D90 was 7.8 Gy(α/β=3Gy). Late toxicity: 8 G1 and 9 G2. Median EQD2(α/β=3Gy) in vagina was 88.6 Gy (62.8-177.6) for 0.1 cm3, 72.4 Gy (57.1-130.4) for 1 cm3, and 69 Gy (53-113.4) for 2 cm3. Exclusive VBT vs. EBRT+VBT showed no differences in vaginal toxicity. There was no relationship between EQD2(α/β=3Gy) at 0.1 cm3 and 1 cm3 of vagina with G1-G2 toxicity (p = 0.62 and p = 0.58, respectively). G2 toxicity was related to EQD2(α/β=3Gy) at 2 cm3 (p = 0.03). EQD2(α/β=3Gy) > 68 Gy caused G2 late toxicity in 20.5% patients. All patients presenting G2 toxicity received > 68 Gy EQD2(α/β=3Gy).ConclusionsMore than 68 Gy EQD2(α/β=3Gy) at 2 cm3 was related to G2 toxicity in P-EC-VBT. Further studies including larger number of patients are needed to confirm these results. Patients receiving these doses should be informed of the risk of toxicity, with individualized treatment planning and follow-up to reduce G2 toxicity.

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“…α/β of HR-CTV was 10 Gy, while for OARs, 3 Gy was applied. The following dose-volume parameters were used for quantitative evaluation of plans [ 35 ]: V 150 : relative volume of IR-CTV, HR-CTV, and GTV receiving at least 150% of the prescribed dose (%), D 90 , D 98 : minimum dose delivered to 90% and 98% of IR-CTV, HR-CTV, and GTV (Gy), D A : dose to point A (Gy), DNR: dose non-uniformity ratio [ 36 ], COIN: conformal index [ 37 ], D 2 : minimal dose of the most exposed 2 cm 3 of a critical organ, including the bladder, rectum, sigmoid, bowel, and vaginal wall (Gy), D ICRU : dose to ICRU reference point of the bladder and rectum (recto-vaginal point) (Gy) [ 38 ], D PIBS : dose to the point of posterior-inferior border of the symphysis (Gy), D PIBS+2 : dose to the point 2 cm above posterior-inferior border of the symphysis parallel to applicator axis (Gy), D PIBS-2 : dose to the point 2 cm below posterior-inferior border of the symphysis parallel to applicator axis (Gy). …”

Section: Methodsmentioning

confidence: 99%

Are active dwell positions always necessary in the ring/ovoids channel of the cervical applicator in the intracavitary-interstitial brachytherapy of cervical cancer?

Fröhlich¹,

Vízkeleti²,

Nguyen³

et al. 2023

jcb

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Purpose: To compare dosimetric parameters of brachytherapy (BT) treatment plans made with or without active source positions of the ring/ovoid (R/O) applicator in locally advanced cervical cancer patients.Material and methods: Sixty patients with cervical cancer without vaginal involvement were selected for the study, who received intra-cavitary/interstitial BT. For each patient, two plans with and without active source dwell positions in R/O were created, using the same dose-volume constraints. EQD 2 total doses from external beam and BT of target volumes and organs at risk (OARs) between the competing plans were compared.Results: There was no significant difference in the dose of high-risk clinical target volume (HR-CTV) and gross tumor volume (GTV) between the plans with inactive vs. active R/O. The mean D 98 of intermediate-risk clinical target volume (IR-CTV) was significantly lower with inactive R/O; however, the GEC-ESTRO (EMBRACE II study) and ABS criteria were fulfilled in 96% in both plans. There was no difference in dose homogeneity, but conformity of the plans with inactive R/O was higher. Doses to all OARs were significantly lower in plans without R/O activation. While all the plans without R/O activation fulfilled the recommended dose criteria for OARs, it was less achievable with R/O activation.Conclusions: Inactivation of R/O applicator results in similar dose coverage of the target volumes with lower doses to all OARs, as activation of R/O in cervix cancer patients when HR-CTV does not extend to R/O applicator. The use of active source positions in R/O shows worse performance regarding the fulfilment of the recommended criteria for OARs.

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Vaginal dose assessment in image-guided brachytherapy for cervical cancer: Can we really rely on dose-point evaluation?

Cited by 9 publications

References 24 publications

Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

Late G2 vagina toxicity in post-operative endometrial carcinoma is associated with a 68 Gy dose equivalent to 2 Gy per fraction (α/β=3Gy) at 2 cm 3 of vagina

Are active dwell positions always necessary in the ring/ovoids channel of the cervical applicator in the intracavitary-interstitial brachytherapy of cervical cancer?

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