Early morbidity and dose-volume effects in definitive radiochemotherapy for locally advanced cervical cancer : a prospective cohort study covering modern treatment techniques
Seppenwoolde, Y. (Department of Radiation Oncology. Erasmus MC Cancer Institute)
Majercakova, Katarina (Institut d'Investigació Biomèdica Sant Pau)
Buschmann, M. (Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology. Medical University of Vienna)
Dörr, E. (Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology. Medical University of Vienna)
Sturdza, A.E. (Department of Radiation Oncology. Comprehensive Cancer Center. Medical University of Vienna/AKH Wien)
Schmid, M.P. (Department of Radiation Oncology. Comprehensive Cancer Center. Medical University of Vienna/AKH Wien)
Pötter, R. (Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology. Medical University of Vienna)
Georg, D. (Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology. Medical University of Vienna)

Date:	2021
Abstract:	Purpose: Predicting morbidity for patients with locally advanced cervix cancer after external beam radiotherapy (EBRT) based on dose-volume parameters remains an unresolved issue in definitive radiochemotherapy. The aim of this prospective study was to correlate patient characteristics and dose-volume parameters to various early morbidity endpoints for different EBRT techniques, including volumetric modulated arc therapy (VMAT) and adaptive radiotherapy (ART). Methods and materials: The study population consisted of 48 patients diagnosed with locally advanced cervix cancer, treated with definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT). Multiple questionnaires (CTCAE 4. 03, QLQ-C30 and EORTC QLQ-CX24) were assessed prospectively for patients treated with different EBRT techniques, including online adaptive VMAT. Contouring and treatment planning was based on the EMBRACE protocols. Acute toxicity, classified as general, gastrointestinal (GI) or genitourinary (GU) and their corresponding dose-volume histograms (DVHs) were first correlated by applying least absolute shrinkage and selection operator (LASSO) and subsequently evaluated by multiple logistic binomial regression. Results: The treated EBRT volumes varied for the different techniques with ~2500 cm for 3D conformal radiotherapy (3D-CRT), ~2000 cm for EMBRACE‑I VMAT, and ~1800 cm for EMBRACE-II VMAT and ART. In general, a worsening of symptoms during the first 5 treatment weeks and recovery afterwards was observed. Dose-volume parameters significantly correlating with stool urgency, rectal and urinary incontinence were as follows: bowel V < 250 cm, rectum V < 80% and bladder V < 80-90%. Conclusion: This prospective study demonstrated the impact of EBRT treatment techniques in combination with chemotherapy on early morbidity. Dose-volume effects for dysuria, urinary incontinence, stool urgency, diarrhea, rectal bleeding, rectal incontinence and weight loss were found.
Note:	Altres ajuts: Federal Ministry for Digital and Economic Affairs (Austrian); National Foundation for Research, Technology and Development (Austrian).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Image-guided adaptive radiotherapy ; Radiotherapy ; Brachytherapy ; Organs-at-risk toxicity ; Quality of life
Published in:	Strahlentherapie und Onkologie, Vol. 197 Núm. 6 (june 2021) , p. 505-519, ISSN 1439-099X

DOI: 10.1007/s00066-021-01781-6
PMID: 33929558

15 p, 2.3 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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