Tolerance of the vaginal vault to high-dose rate brachytherapy and concomitant chemo-pelvic irradiation: Long-term perspective

Abstract

The maximal surface HDR brachytherapy dose of 103 Gy and the maximal cBED of 878.6 Gy3 were not associated with fistula or necrosis or other grade 3-4 vaginal complications. Concomitant chemo-radiotherapy, including pelvic radiotherapy and high-dose-rate intracavitary brachytherapy, is relatively safe for cervical cancer patients.

Vaginal Toxicity Management in Patients with Locally Advanced Cervical Cancer following Exclusive Chemoradiation—A Nationwide Survey on Knowledge and Attitudes by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gynecology Study Group

“…Despite, over the years, clear guidelines that have been developed to address specifics of organs at risk (OARs) and target volume definitions, independently of radiotherapy techniques [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ], little attention has been paid to the resultant vaginal toxicity that women could experience during follow-up in the short and long term. This aspect was partly left out due to the historical idea that the vagina was considered a radioresistant organ; however, a differential radiosensibility was recognized for the upper vagina compared to the middle-inferior vagina, the latter being more radiosensible [ 13 , 14 , 15 , 16 ].…”

Acute radiation toxicity during and after concurrent chemoradiotherapy in patients with localy advanced cervical cancer

“…In a therapeutic setting, the cervix tolerates high radiation dose, and for this reason, the total dose delivered is increased by concomitant use of external beam RT and brachytherapy. There are different modalities of brachytherapy such as high-dose-rate (HDR) brachytherapy, low-doserate, middle-dose-rate, and pulse-dose-rate 18,19,20 . However, HDR is currently the most commonly used, because treatment time is the shortest and the most comfortable for the patients, compared to other modalities.…”