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Bladder (ICRU) dose point does not predict urinary acute toxicity in adjuvant isolated vaginal vault high-dose-rate brachytherapy for intermediate-risk endometrial cancer.

Sapienza LG, Aiza A, Gomes MJ, Chen MJ, Pellizzon AC, Mansur DB, Baiocchi G - J Contemp Brachytherapy (2015)

Bottom Line: After a median follow-up of 36.8 months, the 3-year local failure and 5-year cancer-specific and overall survival rates were 2.1%, 100%, and 94.6%, respectively.No pelvic failure was seen in this cohort.Age over 60 years (p = 0.48), lymphatic invasion (p = 0.77), FIGO histological grade (p = 0.76), isthmus invasion (p = 0.68), and applicator type (cylinder × ovoid) (p = 0.82) did not significantly affect local control.

View Article: PubMed Central - PubMed

Affiliation: Clínicas Oncológicas Integradas (COI), Rio de Janeiro, Brazil ; A.C. Camargo Cancer Center, São Paulo, Brazil.

ABSTRACT

Purpose: High-dose-rate brachytherapy (HDR-BT) alone is an adjuvant treatment option for stage I intermediaterisk endometrial cancer after complete surgical resection. The aim of this study was to determine the value of the dose reported to ICRU bladder point in predicting acute urinary toxicity. Oncologic results are also presented.

Material and methods: One hundred twenty-six patients were treated with postoperative HDR-BT 24 Gy (4 × 6 Gy) per ICRU guidelines for dose reporting. Cox analysis was used to identify variables that affected local control. The mean bladder point dose was examined for its ability to predict acute urinary toxicity.

Results: Two patients (1.6%) developed grade 1 gastrointestinal toxicity and 12 patients (9.5%) developed grades 1-2 urinary toxicity. No grade 3 or greater toxicity was observed. The mean bladder point dose was 46.9% (11.256 Gy) and 49.8% (11.952 Gy) for the asymptomatic and symptomatic groups, respectively (p = 0.69). After a median follow-up of 36.8 months, the 3-year local failure and 5-year cancer-specific and overall survival rates were 2.1%, 100%, and 94.6%, respectively. No pelvic failure was seen in this cohort. Age over 60 years (p = 0.48), lymphatic invasion (p = 0.77), FIGO histological grade (p = 0.76), isthmus invasion (p = 0.68), and applicator type (cylinder × ovoid) (p = 0.82) did not significantly affect local control.

Conclusions: In this retrospective study, ICRU bladder point did not correlate with urinary toxicity. Four fractions of 6 Gy HDR-BT effected satisfactory local control, with acceptable urinary and gastrointestinal toxicity.

No MeSH data available.


Related in: MedlinePlus

Example of simple orthogonal X-ray images used for localization of vaginal cylinder and ICRU bladder (white arrow) and ICRU rectal reference points (black arrow) per the ICRU 38 report. A) Anteroposterior projection. B) Lateral projection
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Figure 0001: Example of simple orthogonal X-ray images used for localization of vaginal cylinder and ICRU bladder (white arrow) and ICRU rectal reference points (black arrow) per the ICRU 38 report. A) Anteroposterior projection. B) Lateral projection

Mentions: Dosimetric data were obtained from the treatment planning system (Eclipse®, version 11.0, Varian, Palo Alto, CA, USA) using simple orthogonal X-ray images (Figure 1). Reference points for rectal and bladder doses were acquired per ICRU 38 guidelines [12]. Briefly, the point of reference for the rectal dose was determined in the lateral radiograph, 5 mm behind the posterior vaginal wall, posterior to the vaginal applicator. The bladder reference point was obtained using a Foley catheter with the balloon filled with 7 cc of radio-opaque fluid. The catheter was pulled downward to bring the balloon against the urethra. On the lateral radiograph, the bladder reference point was identified on the posterior surface of the balloon, on an anterior-posterior line through the center of the balloon. On the anterior-posterior (AP) radiograph, the reference point was taken as the center of the balloon.


Bladder (ICRU) dose point does not predict urinary acute toxicity in adjuvant isolated vaginal vault high-dose-rate brachytherapy for intermediate-risk endometrial cancer.

Sapienza LG, Aiza A, Gomes MJ, Chen MJ, Pellizzon AC, Mansur DB, Baiocchi G - J Contemp Brachytherapy (2015)

Example of simple orthogonal X-ray images used for localization of vaginal cylinder and ICRU bladder (white arrow) and ICRU rectal reference points (black arrow) per the ICRU 38 report. A) Anteroposterior projection. B) Lateral projection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663209&req=5

Figure 0001: Example of simple orthogonal X-ray images used for localization of vaginal cylinder and ICRU bladder (white arrow) and ICRU rectal reference points (black arrow) per the ICRU 38 report. A) Anteroposterior projection. B) Lateral projection
Mentions: Dosimetric data were obtained from the treatment planning system (Eclipse®, version 11.0, Varian, Palo Alto, CA, USA) using simple orthogonal X-ray images (Figure 1). Reference points for rectal and bladder doses were acquired per ICRU 38 guidelines [12]. Briefly, the point of reference for the rectal dose was determined in the lateral radiograph, 5 mm behind the posterior vaginal wall, posterior to the vaginal applicator. The bladder reference point was obtained using a Foley catheter with the balloon filled with 7 cc of radio-opaque fluid. The catheter was pulled downward to bring the balloon against the urethra. On the lateral radiograph, the bladder reference point was identified on the posterior surface of the balloon, on an anterior-posterior line through the center of the balloon. On the anterior-posterior (AP) radiograph, the reference point was taken as the center of the balloon.

Bottom Line: After a median follow-up of 36.8 months, the 3-year local failure and 5-year cancer-specific and overall survival rates were 2.1%, 100%, and 94.6%, respectively.No pelvic failure was seen in this cohort.Age over 60 years (p = 0.48), lymphatic invasion (p = 0.77), FIGO histological grade (p = 0.76), isthmus invasion (p = 0.68), and applicator type (cylinder × ovoid) (p = 0.82) did not significantly affect local control.

View Article: PubMed Central - PubMed

Affiliation: Clínicas Oncológicas Integradas (COI), Rio de Janeiro, Brazil ; A.C. Camargo Cancer Center, São Paulo, Brazil.

ABSTRACT

Purpose: High-dose-rate brachytherapy (HDR-BT) alone is an adjuvant treatment option for stage I intermediaterisk endometrial cancer after complete surgical resection. The aim of this study was to determine the value of the dose reported to ICRU bladder point in predicting acute urinary toxicity. Oncologic results are also presented.

Material and methods: One hundred twenty-six patients were treated with postoperative HDR-BT 24 Gy (4 × 6 Gy) per ICRU guidelines for dose reporting. Cox analysis was used to identify variables that affected local control. The mean bladder point dose was examined for its ability to predict acute urinary toxicity.

Results: Two patients (1.6%) developed grade 1 gastrointestinal toxicity and 12 patients (9.5%) developed grades 1-2 urinary toxicity. No grade 3 or greater toxicity was observed. The mean bladder point dose was 46.9% (11.256 Gy) and 49.8% (11.952 Gy) for the asymptomatic and symptomatic groups, respectively (p = 0.69). After a median follow-up of 36.8 months, the 3-year local failure and 5-year cancer-specific and overall survival rates were 2.1%, 100%, and 94.6%, respectively. No pelvic failure was seen in this cohort. Age over 60 years (p = 0.48), lymphatic invasion (p = 0.77), FIGO histological grade (p = 0.76), isthmus invasion (p = 0.68), and applicator type (cylinder × ovoid) (p = 0.82) did not significantly affect local control.

Conclusions: In this retrospective study, ICRU bladder point did not correlate with urinary toxicity. Four fractions of 6 Gy HDR-BT effected satisfactory local control, with acceptable urinary and gastrointestinal toxicity.

No MeSH data available.


Related in: MedlinePlus