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

Radiation Oncology

Jun Itami¹  Yoshinori Ito¹  Madoka Morota¹  Koji Inaba¹  Kotaro Yoshio¹  Kana Takahashi¹  Shuhei Sekii¹  Mayuka Kitaguchi¹  Ken Harada¹  Ryoichi Yoshimura²  Minako Sumi¹  Takahiro Kasamatsu³  Naoya Murakami¹ 

[1] Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji Chuo-ku, Tokyo 104-0045, Japan;Department of Radiology, Showa University School of Medicine, 1-5-8, Hatanodai Shinagawa-ku, Tokyo 142-8666, Japan;Department of Gynecologic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji Chuo-ku, Tokyo 104-0045, Japan

关键词: Vaginal ulcer;    Interstitial brachytherapy;    High-dose-rate brachytherapy;    Gynecologic brachytherapy;   

Others  :  814956
DOI  :  10.1186/1748-717X-9-31

 received in 2013-07-21, accepted in 2014-01-19,  发布年份 2014

【 摘 要 】

Background

Purpose 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.

Methods

Records 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.

Results

The 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 D_2cc for rectum and bladder, D_0.5cc, D_1cc, D_2cc, D_4cc, D_6cc and D_8cc 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 D_2cc for rectum and bladder, D_0.5cc, D_1cc, D_2cc, D_4cc, D_6cc and D_8cc 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 D_2cc in EQD₂ was the clinical predictors of vaginal ulcer (p = 0.035 and p = 0.025, respectively). The ROC analysis revealed that vaginal wall D_2cc is the best predictor of vaginal ulcer. The 2-year incidence rates of vaginal ulcer in the patients with vaginal wall D_2cc 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).

Conclusions

Re-irradiation and vaginal D_2cc 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 D_2cc in order to avoid vagina ulcer.

【 授权许可】

   
2014 Murakami et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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