Dose-volume histogram predictors of chronic gastrointestinal complications after radical hysterectomy and postoperative intensity modulated radiotherapy for early-stage cervical cancer.

Zhongjie Chen,Ping Wang,Bailin Zhang,Maobin Meng,Li Zhu,Zhiyong Yuan

doi:10.1186/1471-2407-14-789

Zhongjie Chen, Ping Wang + Show 4 more

Open Access

https://doi.org/10.1186/1471-2407-14-789

Copy DOI

Abstract

BackgroundThe small bowel is one of the critical organs involved in gastrointestinal complications in cervical cancer treated with postoperative intensity modulated radiotherapy. Even with modest doses of radiation therapy (45-50Gy), the risk of severe injury from postoperative radiation therapy is between 5% and 15%. Up to now, a predictive model of acute GI complications of the small bowel has been established with the aid of Quantitative Analyses of Normal Tissue Effects in the Clinic. However, the correlation between dose-volume effect and chronic GI complications of the small bowel has not been extensively investigated. In the article, the correlation has been studied preliminarily.MethodsThis study analyzed 84 patients who underwent postoperative IMRT. The organ at risk that was contoured was the small bowel loops. DVH parameters subjected to analysis included maximum and mean dose, the volume of these organs receiving more than 30, 40, and 50 Gy (V30-50 volume) and the volume of V30-50 to total volume (V30-50 ratio). Association between DVH parameters or clinical factors and the incidence of grade 1–2 chronic GI complications were evaluated.ResultsBody position and RT total dose are significantly associated with grade 1–2 chronic GI complications after postoperative IMRT in early-stage cervical cancer patients. Maximum dose and V40 ratio of the small bowel loops were significantly associated with chronic GI complications (P < 0.05). The optimal threshold were 5586 cGy (maximum dose) and 28% (V40 ratio) of the small bowel loops.ConclusionsMaximum dose and V40 ratio of the small bowel loops should be considered synthetically before postoperative IMRT for early-stage cervical cancer.

Highlights

The small bowel is one of the critical organs involved in gastrointestinal complications in cervical cancer treated with postoperative intensity modulated radiotherapy
After hysterectomy, small bowel tends to fall into the vacated space in the true pelvis, increasing the amount of bowel treated to high dose
Treatment criteria for postoperative intensity modulated radiotherapy (IMRT) were indicated according to Adjuvant Treatment in the NCCN Guidelines for cervical cancer [1,8,9,10,11]. 11 of these patients were excluded from the study: 3 who received extended-field radiation therapy because of para-aortic lymph node metastases; 3 who received re-radiotherapy because of pelvic lymph node metastases after the primary radiotherapy; and 5 who died because of distant metastases after postoperative IMRT

Summary

Introduction

The small bowel is one of the critical organs involved in gastrointestinal complications in cervical cancer treated with postoperative intensity modulated radiotherapy. A predictive model of acute GI complications of the small bowel has been established with the aid of Quantitative Analyses of Normal Tissue Effects in the Clinic. The correlation between dose-volume effect and chronic GI complications of the small bowel has not been extensively investigated. Adjuvant whole pelvic radiation therapy (WPRT) after radical hysterectomy reduces locoregional recurrence in cervical cancer patients after surgery with adverse risk factors [1,2]. A predictive model of acute GI complications of the small bowel has been established with the aid of Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) [7]

Methods

Results

Discussion

Conclusion