Avtor/Urednik		Spampinato, Sofia; Fokdal, Lars U.; Pötter, Richard; Haie-Meder, Christine; Lindegaard, Jacob Christian; Schmid, Maximilian; Sturdza, Alina; Jürgenliemk-Schulz, Ina Maria; Mahantshetty, Umesh; Šegedin, Barbara
Naslov		Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer
Tip		članek
Vol. in št.		, št. Vol. 158
Leto izdaje		2021
Obseg		str. 312-320
ISSN		0167-8140 - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Jezik		eng
Abstrakt		Morbidity within the EMBRACE-I study was prospectively reported for physician-assessed (CTCAE) fistula, bleeding and cystitis and patient-reported (EORTC) pain and difficulty in voiding. Analysis of risk factors was performed in patients without bladder infiltration. Risk factors were tested with Cox regression for G%3 cystitis, for G%2 fistula, bleeding and cystitis, and for EORTC "very much" and "quite a bit" or worse. Results: Of 1416 patients enrolled, 1153 and 884 patients without bladder infiltration were evaluable for the analysis of CTCAE and EORTC items, respectively. Median follow-up was 48[3-120] months. Crude incidence rates for G%2 fistula, bleeding and cystitis were 0.7%, 2.7% and 8.8%, respectively, and 16% and 14% for "quite a bit" or worse pain and difficulty in voiding, respectively. Baseline urinary morbidity and overweight/obesity were significant risk factors for most endpoints. Bladder D2cm3 correlated with G%2 fistula, bleeding and cystitis, while ICRU bladder point dose correlated with EORTC pain "quite a bit" or worse. An increase from 75Gy to 80Gy in bladder D2cm3 resulted in an increase from 8% to 13% for 4-year actuarial estimate of G%2 cystitis. Conclusion: Clinical and treatment-related risk factors for bladder fistula, bleeding and cystitis were identified within a prospective and multi-institutional setting. A dose-effect was established with bladder D2cm3, reinforcing the importance of continued optimization during individualized IGABT planning.
Proste vsebinske oznake		rak materničnega vratu radioterapija brahiterapija slikovno vodena brahiterapija cervical cancer radiotherapy brachytherapy imaged-guided adaptive brachytherapy