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Vaginal Dose, Toxicity and Sexual Outcomes in Patients of Cervical Cancer Undergoing Image Based Brachytherapy

  • Rai, Bhavana (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research) ;
  • Dhanireddy, Bhaswanth (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research) ;
  • Patel, Firuza Darius (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research) ;
  • Kumari, Reena (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research) ;
  • Oinam, Arun Singh (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research) ;
  • Simha, Vijai (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research) ;
  • Sharma, Suresh (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
  • Published : 2014.04.30

Abstract

Background: The aim of the study was to evaluate the vaginal dose and toxicity in patients of cervical cancer treated with image guided brachytherapy at our institute. Materials and Methods: Thirty-five patients treated with image based brachytherapy for cervical cancer were included. Vaginal contouring was done on MRI at brachytherapy and with CT scans of subsequent brachytherapy fractions. Dose volume parameters (DVH) were reported in accordance with the GEC-ESTRO guidelines. These were correlated with vaginal toxicity (assessed by CTCAE version 3) and quality of sexual life assessed at one year of completion of treatment. Results: Vaginal shortness was observed in 22 out of 30 (62.8%) patients, Nine (25.7%) had vaginal dryness and in 10 (28.5%) patients, there was contact bleeding. No association could be demonstrated between the dose volume parameters and vaginal toxicity in the present study. Conclusions: The lack of association between dose volume parameters of vagina with vaginal morbidity may be due to uncertainties involved in the delineation of vaginal wall and dosimetry. Future research is required to accurately define vaginal dose distribution to study its correlation with vaginal morbidity. Vaginal morbidity needs to be documented in order to improve the sexual outcome in these patients.

Keywords

References

  1. Au SP, Grigsby PW (2003). The irradiation tolerance dose of the proximal vagina. Radiother Oncol, 67, 77-85. https://doi.org/10.1016/S0167-8140(02)00384-5
  2. Bahng AY, Dagan A, Bruner DW, et al (2012). Determination of prognostic factors for vaginal mucosal toxicity associated with intravaginal high-dose rate brachytherapy in patients with endometrial cancer. Int J Radiat Oncol Biol Phys, 8, 667-73.
  3. Berger D, Dimopoulos J, Georg P, et al (2007). Uncertainties in assessment of the vaginal dose for intracavitary brachytherapy of cervical cancer using a tandem-ring applicator. Int J Radiat Oncol Biol Phys, 67, 1451-9. https://doi.org/10.1016/j.ijrobp.2006.11.021
  4. Bergmark K, Avall-Lundqvist E, Dickman PW, et al (1999). Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med, 340, 1383-9. https://doi.org/10.1056/NEJM199905063401802
  5. Dimopoulos JC, Schard G, Berger D, et al (2006). Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Radiat Oncol Biol Phys, 64, 1380-8. https://doi.org/10.1016/j.ijrobp.2005.10.017
  6. Eifel PJ, Levenback C, Wharton JT, et al (1995). Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys, 32, 1289-300. https://doi.org/10.1016/0360-3016(95)00118-I
  7. Fidarova EF, Berger D, Schussler S, et al (2010). Dose volume parameter D2cc does not correlate with vaginal side effects in individual patients with cervical cancer treated within a defined treatment protocol with very high brachytherapy doses. Radiother Oncol, 97, 76-9. https://doi.org/10.1016/j.radonc.2010.05.005
  8. Frumovitz M, Sun CC, Schover LR, et al (2005). Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol, 23, 7428-36. https://doi.org/10.1200/JCO.2004.00.3996
  9. Gondi V, Bentzen SM, Sklenar KL, et al (2012). Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an interera analysis. Int J Radiat Oncol Biol Phys, 84, 973-982. https://doi.org/10.1016/j.ijrobp.2012.01.064
  10. Greimel ER, Kuljanic Vlasic K, Waldenstrom AC, et al (2006). The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Cervical Cancer Module: EORTC QLQ-CX24. Cancer, 14, 1812-22.
  11. Grover S, Hill-Kayser CE, Vachani C, et al (2012). Patient reported late effects of gynecological cancer treatment. Gynecol Oncol, 124, 399-403. https://doi.org/10.1016/j.ygyno.2011.11.034
  12. Haie-Meder C, Kramar A, Lambin P, et al (1994). Analysis of complications in a prospective randomized trial comparing two brachytherapy low dose rates in cervical carcinoma. Int J Radiat Oncol Biol Phys, 29, 953-60. https://doi.org/10.1016/0360-3016(94)90388-3
  13. Jensen PT, Groenvold M, Klee MC, et al (2004). Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study. Cancer, 100, 97-106. https://doi.org/10.1002/cncr.11877
  14. Lammerink EA, de Bock GH, Pras E, et al (2012). Sexual functioning of cervical cancer survivors: a review with a female perspective. Maturitas, 72, 296-304. https://doi.org/10.1016/j.maturitas.2012.05.006
  15. Miles T, Johnson N (2010). Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev, 9.
  16. Nout RA, Putter H, Jürgenliemk-Schulz IM, et al (2009). Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol, 27, 3547-56. https://doi.org/10.1200/JCO.2008.20.2424
  17. Nout RA, Putter H, Jurgenliemk-Schulz IM, et al (2012). Fiveyear quality of life of endometrial cancer patients treated in the randomised post operative radiation therapy in endometrial cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer, 48, 1638-48. https://doi.org/10.1016/j.ejca.2011.11.014
  18. Pesee M, Krusun S, Padoongcharoen P (2012). High dose rate cobalt-60 after loading intracavitary therapy of the uterine cervical carcinoma in srinagarind hospital, analysis of residual disease. Asian Pac J Cancer Prev,13, 4835-7. https://doi.org/10.7314/APJCP.2012.13.9.4835
  19. Potter R, Georg P, Dimopoulos JC, et al (2011). Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol, 100, 116-23. https://doi.org/10.1016/j.radonc.2011.07.012
  20. Potter R, Haie-Meder C, Limbergen EV, et al (2006). Recommendations from gynecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, and radiobiology. Radiother Oncol, 78, 67-77. https://doi.org/10.1016/j.radonc.2005.11.014
  21. Westerveld H , Potter R, Berger D, et al (2013). Vaginal dose point reporting in cervical cancer patients treated with combined 2D/3D external beam radiotherapy and 2D/3D brachytherapy. Radiother Oncol, 107, 99-105. https://doi.org/10.1016/j.radonc.2013.04.009
  22. Yang L, Lv Y (2012). Possible risk factors associated with radiation proctitis or radiation cystitis in patients with cervical carcinoma after radiotherapy. Asian Pac J Cancer Prev, 13, 6251-5. https://doi.org/10.7314/APJCP.2012.13.12.6251
  23. Zhao YB, Wang JH, Chen XX, et al (2012). Values of three different preoperative regimens in comprehensive treatment for young patients with stage Ib2 cervical cancer. Asian Pac J Cancer Prev, 13, 1487-9. https://doi.org/10.7314/APJCP.2012.13.4.1487

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