Vaginal 11-point and volumetric dose related to late vaginal complications in patients with cervical cancer treated with external beam radiotherapy and image-guided adaptive brachytherapy

Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation for Anal Cancer: Using the Anterior Vaginal Wall as an Organ-at-Risk to Define an Actionable Dosimetric Goal

“… 6 A number of studies have demonstrated the utility of this vaginal dose reporting system for cervical cancer including validation in the image-guided intensity modulated External beam radiochemotherapy and Magnetic resonance imaging–based adaptive BRAchytherapy in locally advanced CErvical cancer (EMBRACE) studies. 7 , 8 , 11 , 12 To our knowledge, Son et al in 2015 is the only report to investigate vaginal dosimetry and propose an actionable clinical goal specifically for the treatment of lower gastrointestinal cancers. 9 They identified generalized equivalent uniform dose and vaginal mean dose as significant predictors of vaginal stenosis, with a reduction of severe stenosis when generalized equivalent uniform dose <35 Gy and mean dose <43 Gy ( P = .02).…”

“…Most prior studies investigating the relationship between vaginal dosimetry and sexual toxicity have used the full vaginal canal as the relevant organ at risk (OAR), most often in the setting of gynecologic cancers. 6 , 7 , 8 , 9 , 10 , 11 , 12 Consensus target delineation guidelines for anal cancer radiation therapy recommend geometric expansions from the gross tumor volume to define high-dose target volumes. 13 This often leads to large portions of the posterior vaginal wall being included in the prescription volumes and, therefore, prevents meaningful avoidance of the full vaginal canal OAR.…”

Dose-response relationship between volume base dose and tumor local control in definitive radiotherapy for vaginal cancer

“…Our study fills the gap in this regard. The studies of the dose toxicity relationship of the vagina as a normal tissue have provided dose constraints for clinical practice [ 38 – 40 ]. Combined with the results of this study, radiation oncologists can seek an optimal window for achieving high local tumor control while maintaining low side effects for OARs.…”