Radiation therapy alone in the treatment of carcinoma of the uterine cervix. II. Analysis of complications

Abstract

A retrospective analysis was carried out on 811 patients with histologically proven invasive carcinoma of the uterine cervix treated with irradiation alone. A correlation was made of the doses of irradiation delivered to the pelvic organs with external beam and intracavitary insertions. Approximately 3% of the patients exhibited grade 2 gastrointestinal complications, and 2% developed grade 2 urinary complications; 5% of the patients developed grade 3 gastrointestinal complications, and 3% developed grade 3 urinary complications. Other types of complications, primarily grade 2, such as vaginal necrosis, pelivic abscess, thrombophlebitis, etc, were seen in approximately 5% of the patients. Thus, the total percentage of patients developing grade 2 complicatins was 10% and grade 3 complications, approximately 8%. About 25% of the patients who had complications showed more than one sequela. The most frequently observed grade 2 complications were proctitis, cystitis, vaginal stenosis, and partial small bowel obstruction which were treated with conservative management. Grade 3 complications required surgical treatment and consisted most frequently of ureteral stricture, vesicovaginal fistula, rectovaginal fistula, sigmoid stricture, small bowel obstruction, proctitis, and large rectal ulcers. The most significant factor affecting the appearance of complications was the total dose of irradiation delivered to the pelvic organs by the whole pelvis external irradiation and intracavitary insertions. With maximum total doses up to 8000 rad the incidence of grade 2 and 3 complications was less than 5%. However, with higher doses the incidence of complications increased to 10% to 15%. In patients receiving total doses of 6000 rad to the bladder or rectum, more complications were noted when only one intracavitary insertion was performed, as compared with two or three. Eighty percent of the rectosigmoid complications occurred within 30 months of initial therapy, in contrast to 48 months for the urinary complications. Patients who developed complications had survival rates comparable to those without complications. This underscores the need to rapidly institute treatment on patients who have severe injury after radiation therapy. Even though it is difficult to determine the exact total dose delivered to a specific volume within the pelvis, the current study strongly indicates that dose calculations to specific anatomical points may be reliable parameters to use in modifying treatment techniques to deliver doses of irradiation that will not exceed tolerance limits for the pelvic structures, when treating patients with carcinoma of the uterine cervix with irradiation alone.

Long‐term results of high‐dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix

“…8,25,30 In a few studies however, late complications occurring after Ͼ 10 years of treatment have been observed. In the current series, rectosigmoid colon complications occurred most frequently during the first 2 years, after which the incidence decreased markedly.…”

“…In their LDR series, Perez et al 30 and Pourquier et al 31 demonstrated a positive correlation between a dose to the rectum and bladder of Ͼ 80 Gy and severe complications. They reported that the rates of Grade 2 and 3 complications in the urinary tract and rectosigmoid colon were approximately 5% with doses Ͻ 75-80 Gy.…”

Safety of adjuvant intensity-modulated postoperative radiation therapy in endometrial cancer: Clinical data and dosimetric parameters according to the International Commission on Radiation Units (ICRU) 83 report

“…9,10,25,26 In contrast to conventional treatments, IMRT significantly spares the OAR (Table 2). In our series, the small bowel median V40 and V45 of 77 cc and 7 cc, respectively, could not be obtained using conventional 3D conformal therapy alone.…”

Dosimetric parameters that predict late rectal complications after curative radiotherapy in patients with uterine cervical carcinoma

“…Because most centers treat patients who have uterine cervical carcinoma with the Point A dose, many previous studies [5][6][7][8] did not analyze the influence of the BED Point A on the risk of LRC. In addition, some investigators 9,28 noted that the EBRT dose and BED Point A did not correlate with LRC. In the current study, although the EBRT dose and BED Point A were correlated with LRC Ն Grade 2 in the univariate analysis, those parameters were not correlated in the multivariate analysis.…”

“…Several investigators [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] previously demonstrated that various clinical and treatment-related parameters, including age, diabetes mellitus, disease stage, EBRT dose, fractionation of brachytherapy, Point A dose, and rectal dose, were correlated with late rectal complications (LRC). In particular, RT dose and volume are considered the most important parameters associated with LRC.…”