Browse > Article
http://dx.doi.org/10.7314/APJCP.2014.15.8.3619

Vaginal Dose, Toxicity and Sexual Outcomes in Patients of Cervical Cancer Undergoing Image Based Brachytherapy  

Rai, Bhavana (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Dhanireddy, Bhaswanth (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Patel, Firuza Darius (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Kumari, Reena (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Oinam, Arun Singh (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Simha, Vijai (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Sharma, Suresh (Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.15, no.8, 2014 , pp. 3619-3623 More about this Journal
Abstract
Background: The aim of the study was to evaluate the vaginal dose and toxicity in patients of cervical cancer treated with image guided brachytherapy at our institute. Materials and Methods: Thirty-five patients treated with image based brachytherapy for cervical cancer were included. Vaginal contouring was done on MRI at brachytherapy and with CT scans of subsequent brachytherapy fractions. Dose volume parameters (DVH) were reported in accordance with the GEC-ESTRO guidelines. These were correlated with vaginal toxicity (assessed by CTCAE version 3) and quality of sexual life assessed at one year of completion of treatment. Results: Vaginal shortness was observed in 22 out of 30 (62.8%) patients, Nine (25.7%) had vaginal dryness and in 10 (28.5%) patients, there was contact bleeding. No association could be demonstrated between the dose volume parameters and vaginal toxicity in the present study. Conclusions: The lack of association between dose volume parameters of vagina with vaginal morbidity may be due to uncertainties involved in the delineation of vaginal wall and dosimetry. Future research is required to accurately define vaginal dose distribution to study its correlation with vaginal morbidity. Vaginal morbidity needs to be documented in order to improve the sexual outcome in these patients.
Keywords
Radiation; vagina; toxicity; dose volume parameters; sexual outcome;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
연도 인용수 순위
1 Potter R, Haie-Meder C, Limbergen EV, et al (2006). Recommendations from gynecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, and radiobiology. Radiother Oncol, 78, 67-77.   DOI   ScienceOn
2 Zhao YB, Wang JH, Chen XX, et al (2012). Values of three different preoperative regimens in comprehensive treatment for young patients with stage Ib2 cervical cancer. Asian Pac J Cancer Prev, 13, 1487-9.   과학기술학회마을   DOI   ScienceOn
3 Nout RA, Putter H, Jürgenliemk-Schulz IM, et al (2009). Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol, 27, 3547-56.   DOI   ScienceOn
4 Frumovitz M, Sun CC, Schover LR, et al (2005). Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol, 23, 7428-36.   DOI   ScienceOn
5 Gondi V, Bentzen SM, Sklenar KL, et al (2012). Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an interera analysis. Int J Radiat Oncol Biol Phys, 84, 973-982.   DOI   ScienceOn
6 Grover S, Hill-Kayser CE, Vachani C, et al (2012). Patient reported late effects of gynecological cancer treatment. Gynecol Oncol, 124, 399-403.   DOI   ScienceOn
7 Haie-Meder C, Kramar A, Lambin P, et al (1994). Analysis of complications in a prospective randomized trial comparing two brachytherapy low dose rates in cervical carcinoma. Int J Radiat Oncol Biol Phys, 29, 953-60.   DOI
8 Jensen PT, Groenvold M, Klee MC, et al (2004). Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study. Cancer, 100, 97-106.   DOI   ScienceOn
9 Lammerink EA, de Bock GH, Pras E, et al (2012). Sexual functioning of cervical cancer survivors: a review with a female perspective. Maturitas, 72, 296-304.   DOI   ScienceOn
10 Miles T, Johnson N (2010). Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev, 9.
11 Au SP, Grigsby PW (2003). The irradiation tolerance dose of the proximal vagina. Radiother Oncol, 67, 77-85.   DOI   ScienceOn
12 Bahng AY, Dagan A, Bruner DW, et al (2012). 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, 8, 667-73.
13 Westerveld H , Potter R, Berger D, et al (2013). Vaginal dose point reporting in cervical cancer patients treated with combined 2D/3D external beam radiotherapy and 2D/3D brachytherapy. Radiother Oncol, 107, 99-105.   DOI   ScienceOn
14 Nout RA, Putter H, Jurgenliemk-Schulz IM, et al (2012). Fiveyear quality of life of endometrial cancer patients treated in the randomised post operative radiation therapy in endometrial cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer, 48, 1638-48.   DOI   ScienceOn
15 Pesee M, Krusun S, Padoongcharoen P (2012). High dose rate cobalt-60 after loading intracavitary therapy of the uterine cervical carcinoma in srinagarind hospital, analysis of residual disease. Asian Pac J Cancer Prev,13, 4835-7.   과학기술학회마을   DOI   ScienceOn
16 Potter R, Georg P, Dimopoulos JC, et al (2011). Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol, 100, 116-23.   DOI   ScienceOn
17 Yang L, Lv Y (2012). Possible risk factors associated with radiation proctitis or radiation cystitis in patients with cervical carcinoma after radiotherapy. Asian Pac J Cancer Prev, 13, 6251-5.   과학기술학회마을   DOI   ScienceOn
18 Greimel ER, Kuljanic Vlasic K, Waldenstrom AC, et al (2006). The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Cervical Cancer Module: EORTC QLQ-CX24. Cancer, 14, 1812-22.
19 Fidarova EF, Berger D, Schussler S, et al (2010). Dose volume parameter D2cc does not correlate with vaginal side effects in individual patients with cervical cancer treated within a defined treatment protocol with very high brachytherapy doses. Radiother Oncol, 97, 76-9.   DOI   ScienceOn
20 Berger D, Dimopoulos J, Georg P, et al (2007). Uncertainties in assessment of the vaginal dose for intracavitary brachytherapy of cervical cancer using a tandem-ring applicator. Int J Radiat Oncol Biol Phys, 67, 1451-9.   DOI   ScienceOn
21 Bergmark K, Avall-Lundqvist E, Dickman PW, et al (1999). Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med, 340, 1383-9.   DOI   ScienceOn
22 Dimopoulos JC, Schard G, Berger D, et al (2006). Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Radiat Oncol Biol Phys, 64, 1380-8.   DOI   ScienceOn
23 Eifel PJ, Levenback C, Wharton JT, et al (1995). Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys, 32, 1289-300.   DOI   ScienceOn