| Author/Editor | 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 | |
| Title | Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer | |
| Type | članek | |
| Vol. and No. | , št. Vol. 158 | |
| Publication year | 2021 | |
| Volume | str. 312-320 | |
| ISSN | 0167-8140 - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | |
| Language | eng | |
| Abstract | 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. | |
| Keywords | rak materničnega vratu radioterapija brahiterapija slikovno vodena brahiterapija cervical cancer radiotherapy brachytherapy imaged-guided adaptive brachytherapy |