eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
SCImago Journal & Country Rank

vol. 10
Original paper

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 cm3 of vagina

María del Valle Aguilera, Ángeles Rovirosa, Carlos Ascaso, Antonio Herreros, Joan Sánchez, Julia Garcia-Miguel, Stephanía Cortes, Eduardo Agusti, Cristina Camacho, Yaowen Zhang, Yan Li, Sebastià Sabater, Aureli Torne, Meritxell Arenas

J Contemp Brachytherapy 2018; 10, 1: 40–46
Online publish date: 2018/02/28
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
To 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 methods
From 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.

The 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).

More 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.


endometrial cancer, gynecology, late vaginal toxicity, vaginal-cuff

Pötter R, Gerbaulet A, Haie-Meder C. Endometrial cancer. In: The GEC ESTRO Handbook of Brachytherapy. Gerbaulet A, Pötter R, Mazeron JJ et al. (eds.). ACCO, Leuven 2002; 365-401.
Bahng AY, Dagan A, Bruner DW et al. 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 2012; 82: 667-673.
Friedman LC, Abdallah R, Schluchter M et al. Adherence to vaginal dilation following high dose rate brachytherapy for endometrial cancer. Int J Radiat Oncol Biol Phys 2011; 80: 751-757.
Kirchheiner K, Nout RA, Tanderup K et al. Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study. Int J Radiat Oncol Biol Phys 2014; 89: 88-95.
Pötter R, Tanderup K, Kirisits C et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018; 9: 48-60.
Westerveld H, de Leeuw A, Kirchheiner K et al. EMBRACE Collaborative Group. Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients. Radiother Oncol 2016; 120: 420-427.
Kirchheiner K, Nout RA, Lindegaard JC et al. EMBRACE Collaborative Group. Dose-effect relationship and risk factors for vaginal stenosis after definitive radio (chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study. Radiother Oncol 2016; 118: 160-166.
Limkin EJ, Dumas I, Chargari C et al. Vaginal dose assessment in image-guided brachytherapy for cervical cancer: Can we really rely on dose-point evaluation? Brachytherapy 2016, 15: 169-176.
Small W, Mell KL, Anderson P et al. Clinical investigation uterus consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 2008; 71: 428-434.
Rovirosa A, Ascaso C, Sánchez Reyes A et al. Three or four fractions of 4-5 Gy per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. Int J Radiat Oncol Biol Phys 2011; 81: 412-423.
Late effects consensus conference RTOG/EORTC. Radiother Oncol 1995; 35: 5e7.
LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Biol Phys 1995; 31: 1049-1191.
Feldmann U, Schneider B, Klinkers H et al. A multivariate approach for the biometric comparison of analytical methods in clinical chemistry. J Clin Chem Clin Biochem 1981; 19: 121-137.
Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45: 255-268.
Rovirosa A, Valduvieco I, Ascaso C et al. A. Daily schedule for high-dose-rate brachytherapy in postoperative treatment of endometrial carcinoma. Clin Transl Oncol 2013; 15: 111-116.
Rovirosa Á, Ascaso C, Herreros A et al. A new short daily brachytherapy schedule in postoperative endometrial carcinoma. Preliminary results. Brachytherapy 2017; 16: 147-152.
Guinot JL, Pérez-Calatayud J, Azcoaga JM et al. Consensus on treatment of endometrium carcinoma with brachytherapy of SEOR and SEFM brachytherapy group. Clin Transl Oncol 2012; 14: 263-270.
Valduvieco I, Rovirosa Á, Herreros A et al. Three or four fractions per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. The long-term results on vaginal relapses and toxicity. Clin Transl Oncol 2013; 15: 602-607.
Harkenrider MM, Block AM, Alectiar KM et al. American Brachytherapy task group report: adjuvant vaginal brachytherapy for early-stage endometrial cancer: a comprehensive review. Brachytherapy 2017; 16: 95-108.
Rovirosa A, Ascaso C, Arenas M et al. Can we shorten the overall treatment time in postoperative brachytherapy of endometrial carcinoma? Comparison of two brachytherapy schedules. Radiother Oncol 2015; 116: 143-148.
Ríos I, Rovirosa A, Ascaso C et al. Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients. Clin Transl Oncol 2016: 18: 925-930.
Rovirosa A, Ascaso C, Camarasa A et al. EQD23Gy vaginal toxicity study in 2 protracted HDR brachytherapy schedules in postoperative endometrial cancer. Radiother Oncol 2015; 115 (Suppl 1): S547.
Sorbe B, Smet ACh. Postoperative vaginal irradiation with high dose rate afterloading technique in endometrial carcinoma stage I. Int J Radiat Oncol Biol Phys 2000; 18: 305-314.
Sorbe B, Strumits A, Karlsson L. Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer. A randomized study of 2 dose-per-fraction levels. Int J Radiat Oncol Biol Phys 2005; 62: 1385-1389.
Susko M, Craciunescu OI, Meltsner SG et al. Vaginal Toxicity From Vaginal Brachytherapy and Capri-Based Systems. Int J Radiat Oncol Biol Phys 2016; 96 (Suppl 2): E287-E288.
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. May 28, 2009 (v4.03: June 14, 2010). U.S. Department of Health and Human Services. National Institutes of Health. National Cancer Institute. Available at: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_
Miles T, Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev 2010; 9: CD007291.
Laliscia C, Delishaj D, Fabrini MG et al. Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit? J Contemp Brachytherapy 2016; 8: 512-517.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe