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Open Access 01-06-2021 | Brachytherapy | Original Article

Early morbidity and dose–volume effects in definitive radiochemotherapy for locally advanced cervical cancer: a prospective cohort study covering modern treatment techniques

Authors: Yvette Seppenwoolde, Katarina Majercakova, Martin Buschmann, Elke Dörr, Alina E. Sturdza, Maximilian P. Schmid, Richard Pötter, Dietmar Georg

Published in: Strahlentherapie und Onkologie | Issue 6/2021

Abstract

Purpose

Predicting morbidity for patients with locally advanced cervix cancer after external beam radiotherapy (EBRT) based on dose–volume parameters remains an unresolved issue in definitive radiochemotherapy. The aim of this prospective study was to correlate patient characteristics and dose–volume parameters to various early morbidity endpoints for different EBRT techniques, including volumetric modulated arc therapy (VMAT) and adaptive radiotherapy (ART).

Methods and materials

The study population consisted of 48 patients diagnosed with locally advanced cervix cancer, treated with definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT). Multiple questionnaires (CTCAE 4.03, QLQ-C30 and EORTC QLQ-CX24) were assessed prospectively for patients treated with different EBRT techniques, including online adaptive VMAT. Contouring and treatment planning was based on the EMBRACE protocols. Acute toxicity, classified as general, gastrointestinal (GI) or genitourinary (GU) and their corresponding dose–volume histograms (DVHs) were first correlated by applying least absolute shrinkage and selection operator (LASSO) and subsequently evaluated by multiple logistic binomial regression.

Results

The treated EBRT volumes varied for the different techniques with ~2500 cm³ for 3D conformal radiotherapy (3D-CRT), ~2000 cm³ for EMBRACE‑I VMAT, and ~1800 cm³ for EMBRACE-II VMAT and ART. In general, a worsening of symptoms during the first 5 treatment weeks and recovery afterwards was observed. Dose–volume parameters significantly correlating with stool urgency, rectal and urinary incontinence were as follows: bowel V_40Gy < 250 cm³, rectum V_40Gy < 80% and bladder V_40Gy < 80–90%.

Conclusion

This prospective study demonstrated the impact of EBRT treatment techniques in combination with chemotherapy on early morbidity. Dose–volume effects for dysuria, urinary incontinence, stool urgency, diarrhea, rectal bleeding, rectal incontinence and weight loss were found.

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Title: Early morbidity and dose–volume effects in definitive radiochemotherapy for locally advanced cervical cancer: a prospective cohort study covering modern treatment techniques
Authors: Yvette Seppenwoolde
Katarina Majercakova
Martin Buschmann
Elke Dörr
Alina E. Sturdza
Maximilian P. Schmid
Richard Pötter
Dietmar Georg
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Brachytherapy
Radiotherapy
Cytostatic Therapy
Published in: Strahlentherapie und Onkologie / Issue 6/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-021-01781-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early morbidity and dose–volume effects in definitive radiochemotherapy for locally advanced cervical cancer: a prospective cohort study covering modern treatment techniques

Abstract

Purpose

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusion

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