Abstract
Purpose: To evaluate the associations for vaginal dose points of vaginal stricture in image-guided brachytherapy. Materials and Methods: Twenty-six patients of locally advanced cervical cancer were treated with Image-Guided Brachytherapy (IGBT) with the dose at least 7 Gy per fraction to the D90 of High-Risk Clinical Target Volume (HR-CTV). The vaginal dose points of recommendations of the American Brachytherapy Society (ABS) were added into the plan and cumulative dose to these points was evaluated in Equivalent Dose of 2 Gy (EQD2) concepts. Results: The mean doses to right vaginal dose point (VR), left vaginal dose point (VL) and average dose of VR/VL ((VR + VL)/2) were 101.5 Gy, 98.2 Gy and 99.8 Gy in EQD2 concepts, respectively. Volume-based planning significantly reduced the cumulative dose in EQD2 concepts at vaginal points. At the median follow-up time of 22 months, grade-2 vaginal stricture was observed in two patients. The incidences of vaginal stricture were not differed between the cumulative dose to vaginal dose points in EQD2 concepts of ≤90 Gy versus >90 Gy (P = 1.000) and ≤100 Gy versus >100 Gy (P = 0.815). Conclusion: No association for cumulative vaginal doses and events of vaginal stricture was found.
Highlights
Cervical cancer is the most common cancer in females in Thailand
Especially vaginal stricture, is the most common late toxicity that may cause the problem to quality of life
The incidences of vaginal stricture were not differed between the cumulative dose to vaginal dose points in Equivalent Dose of 2 Gy (EQD2) concepts of ≤90 Gy versus >90 Gy (P = 1.000) and ≤100 Gy versus >100 Gy (P = 0.815)
Summary
Cervical cancer is the most common cancer in females in Thailand. In the year of 2005, the incidence of cervical cancer in northern Thailand was 23.5 per 100,000 [1].In case of inoperable or locally advanced stages, radiotherapy (external beam radiotherapy plus brachytherapy) plays a major role in the theraputic management of this setting. In the year of 2005, the incidence of cervical cancer in northern Thailand was 23.5 per 100,000 [1]. According to the developments of ImageGuided Brachytherapy (IGBT) for the treatment of cervical cancer, many publications recently supported these novel techniques to improve the treatment results and betterments of bladder and rectum morbidities were reported extensively in these publications [2]-[5]. The vagina has been defined as relatively radioresistant organs with low incidence of severe late radiation toxicity of only 1% 7% [6] [7]. Recent publications by Gondi et al showed higher incidence of late vaginal toxicity in chemoradiation group [8]. Limited reported data onto vaginal effects of image-guided brachytherapy in volume and point approaches are available [9]
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