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

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
Kathrin KirchheinerEMBRACE Collaborative Group

Abstract

To identify risk factors for vaginal stenosis and to establish a dose-effect relationship for image-guided brachytherapy in locally advanced cervical cancer. Patients from the ongoing EMBRACE study with prospectively assessed morbidity (CTCAEv3.0) at baseline and at least one follow-up were selected. Patient-, disease- and treatment characteristics were tested as risk factors for vaginal stenosis G ⩾ 2 in univariate and multivariable analyses (Cox proportional hazards model) and a dose-effect curve was deduced from the estimates. The ICRU rectum point was used to derive the recto-vaginal reference point dose. In 630 patients included (median follow-up 24months), 2-year actuarial estimate for vaginal stenosis G ⩾ 2 was 21%. Recto-vaginal reference point dose (HR=1.025, p=0.029), external beam radiotherapy (EBRT) dose >45 Gy/25 fractions (HR=1.770, p=0.056) and tumor extension in the vagina (HR=2.259, p ⩽ 0.001) were risk factors for vaginal stenosis, adjusted for center reporting effects. Based on the model curve, the risk was 20% at 65 Gy, 27% at 75 Gy and 34% at 85 Gy (recto-vaginal reference point dose). Keeping the EBRT dose at 45 Gy/25 fractions and decreasing the dose contribution of brachytherapy to the vagina decrease th...Continue Reading

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Citations

Apr 9, 2016·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Jacob Christian LindegaardKari Tanderup
May 31, 2016·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Henrike WesterveldUNKNOWN EMBRACE Collaborative Group
Jun 9, 2016·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Sandy MohamedKari Tanderup
Jul 12, 2016·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Renaud MazeronUNKNOWN EMBRACE collaborative group
Jul 28, 2016·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Nicole NesvacilChristian Kirisits
Aug 25, 2016·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Kari TanderupRichard Pötter
Sep 18, 2016·Advanced Drug Delivery Reviews·Kari TanderupRichard Pötter
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Apr 2, 2021·The Lancet Oncology·Richard PötterUNKNOWN EMBRACE Collaborative Group
Apr 12, 2021·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Jin-Jie YanHai-Qiang Mai
May 20, 2021·American Society of Clinical Oncology Educational Book·Ammoren DohmSarah Hoffe
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Oct 23, 2021·International Journal of Radiation Oncology, Biology, Physics·Sofia Spampinato Embrace Collaborative Group

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