Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer: An EMBRACE analysis

医学 近距离放射治疗 瘘管 泌尿科 宫颈癌 膀胱癌 危险系数 外科 放射治疗 内科学 癌症 置信区间
作者
Sofia Spampinato,Lars Fokdal,Richard Pötter,Christine Haie-Méder,Jacob Christian Lindegaard,Maximilian Schmid,Alina Sturdza,Ina M. Jürgenliemk‐Schulz,Umesh Mahantshetty,Barbara Šegedin,Kjersti Bruheim,Peter Hoskin,Bhavana Rai,Fleur Huang,Rachel Cooper,Elzbieta van der Steen-Banasik,Erik Van Limbergen,Marit Sundset,Henrike Westerveld,Remi A. Nout
出处
期刊:Radiotherapy and Oncology [Elsevier BV]
卷期号:158: 312-320 被引量:45
标识
DOI:10.1016/j.radonc.2021.01.019
摘要

To identify patient- and treatment-related risk factors for fistula, bleeding, cystitis, pain and difficulty in voiding in locally advanced cervical cancer patients treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT).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 grade (G) ≥ 3 cystitis, for G ≥ 2 fistula, bleeding and cystitis, and for EORTC "very much" and "quite a bit" or worse.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 75 Gy to 80 Gy in bladder D2cm3 resulted in an increase from 8% to 13% for 4-year actuarial estimate of G ≥ 2 cystitis.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.
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