Impact of dosimetric and clinical parameters on clinical side effects in cervix cancer patients treated with 3D pulse-dose-rate intracavitary brachytherapy

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• 作者：Mihai Levitchi^a ; ^b ; Claire Charra-Brunaud^a ; ^{c.brunaud@nancy.unicancer.fr} ; Philippe Quetin^c ; Christine Haie-Meder^d ; Christine Kerr^e ; Bernard Castelain^f ; Martine Delannes^g ; Laurence Thomas^h ; Emmanuel Desandesⁱ ; Didier Peiffert^a
• 关键词：Cervical cancer ; Pulsed-dose-rate brachytherapy ; Image-guided brachytherapy ; Dose&ndash ; volume histogram ; Organs at risk ; Side effects
• 刊名：Radiotherapy and Oncology
• 出版年：2012
• 期刊代码：231_01678140
• 类别：med
• 出版时间：June, 2012
• 卷：103
• 期：3
• 页码：314-321
• 文件大小：225 K

摘要

Background and purpose

To assess the association between dosimetric/clinical parameters and gastrointestinal/urinary grade 2-4 side effects in cervix cancer patients treated with 3D pulse dose rate brachytherapy.

Materials and methods

Three hundred and fifty-two patients received brachytherapy associated with external-beam radiotherapy (EBRT) for 266 of them; 236 patients underwent surgery. The doses for the most exposed 2, and 0.1 cm³ (D_2cc and D_0.1cc) volumes of the rectum and bladder as well as bladder ICRU point dose (D_ICRU) were converted into isoeffective doses in 2-Gy fractions. The clinical parameters analyzed were: age, smoking habits, arteritis, diabetes, previous pelvic surgery, FIGO stage, nodal status, pathology, pelvic surgery, EBRT and chemotherapy. Side effects were prospectively assessed using the CTCAEv3.0. Cutoff dose levels were defined separately for patients treated with EBRT and brachytherapy (Group 1) and with preoperative brachytherapy (Group 2).

Results

The median follow-up was 23.4 months. In Group 1 a significant predictive value of rectum D_0.1cc and D_2cc, bladder D_0.1cc and D_ICRU for gastrointestinal and urinary toxicity was found using as cutoff 83, 68, 109 and 68 Gy_伪/尾3. In Group 2 a significant predictive value of bladder D_0.1cc, D_2cc and D_ICRU for urinary toxicity was found using as cutoff 141, 91 and 67 Gy_伪/尾3, but not for the rectum D_0.1cc and D_2cc; smoking had a significant predictive value on urinary toxicity.

Conclusions

For patients treated with brachytherapy and EBRT, rectum D_0.1cc and D_2cc and bladder D_0.1cc and D_ICRU had a predictive value for toxicity. For patients treated with preoperative brachytherapy, bladder D_0.1cc, D_2cc and D_ICRU and smoking had a predictive value for urinary toxicity.