What Causes Vaginal Stenosis in Patients Undergoing Adjuvant Intracavitary Brachytherapy for Endometrial Cancer?

Vakilian, Siavosh; Alsuhaibani, Abdullah; Bahoric, Boris

doi:10.1016/j.ijrobp.2011.06.756

Cited by 2 publications

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“…The incidence of grade 1-2 vaginal toxicity, including atrophy, shortening, and stenosis is approximately 35% when prescribing standard dose brachytherapy [ 19 ]. Concomitant chemotherapy may increase the incidence of vaginal dryness and discomfort in patients undergoing IVB [ 20 ], and furthermore, sexual dysfunction can be related to changes in body image associated with chemotherapy-induced menopause and hair loss. Therefore, lowering the dose to the vaginal mucosa in patients receiving chemotherapy may improve toxicity, however, to our knowledge, this concept has not yet been studied.…”

Section: Discussionmentioning

confidence: 99%

High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma

Damast¹,

Higgins²,

Ratner³

et al. 2015

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PurposeTo evaluate our institutional experience combining carboplatin-paclitaxel (C/T) chemotherapy with high-dose-rate (HDR) intra-vaginal brachytherapy (IVB) following comprehensive surgical staging in localized uterine serous carcinoma (USC).Material and methodsInstitutional chart review identified 56 patients with FIGO 2009 stage I-II USC treated between 2000-2010. Patients underwent total hysterectomy, bilateral salpingo-oopherectomy, and comprehensive surgical staging including pelvic and para-aortic lymph node dissection, omentectomy, and peritoneal cytology. Chemotherapy was 6 cycles of C/T, and the IVB dose was 14 Gy in 2 fractions, prescribed to 0.5 cm from the cylinder surface. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS) and overall survival (OS).ResultsThe median follow-up time was 49 months (range: 9-145). The 5-yr RFS and OS were 85% and 93%, respectively. In all cases of recurrence (n = 8), the first site of failure was extra-pelvic. There were no isolated vaginal recurrences, however, there was one vaginal apex recurrence recorded at 19 months in a patient with simultaneous lung metastases. Thus, the 2-year vaginal RFS was 98%.ConclusionsExcellent vaginal/pelvic control rates were observed. Further study of HDR brachytherapy dose and fractionation in combination with chemotherapy is worthwhile.

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Section: Discussionmentioning

confidence: 99%

High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma

Damast¹,

Higgins²,

Ratner³

et al. 2015

jcb

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“…Although scarcely reported, vaginal stenosis is a common side effect of radiotherapy, occurring in 38% of patients, most often during the first year after treatment, and patients older than 50 years presents the highest risk [ 37 ]. Research has shown that maximum dose to the vaginal vault correlates with stenosis grade, and adjuvant chemotherapy before vaginal cuff brachytherapy is associated with subsequent stenosis [ 39 ]. In an effort to prevent vaginal stenosis, the use of vaginal dilators has been advocated [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Single versus multichannel applicator in high-dose-rate vaginal brachytherapy optimized by inverse treatment planning

Bahadur¹,

Constantinescu²,

Hassouna³

et al. 2014

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PurposeTo retrospectively compare the potential dosimetric advantages of a multichannel vaginal applicator vs. a single channel one in intracavitary vaginal high-dose-rate (HDR) brachytherapy after hysterectomy, and evaluate the dosimetric advantage of fractional re-planning.Material and methodsWe randomly selected 12 patients with endometrial carcinoma, who received adjuvant vaginal cuff HDR brachytherapy using a multichannel applicator. For each brachytherapy fraction, two inverse treatment plans (for central channel and multichannel loadings) were performed and compared. The advantage of fractional re-planning was also investigated.ResultsDose-volume-histogram (DVH) analysis showed limited, but statistically significant difference (p = 0.007) regarding clinical-target-volume dose coverage between single and multichannel approaches. For the organs-at-risk rectum and bladder, the use of multichannel applicator demonstrated a noticeable dose reduction, when compared to single channel, but statistically significant for rectum only (p = 0.0001). For D2cc of rectum, an average fractional dose of 6.1 ± 0.7 Gy resulted for single channel vs. 5.1 ± 0.6 Gy for multichannel. For D2cc of bladder, an average fractional dose of 5 ± 0.9 Gy occurred for single channel vs. 4.9 ± 0.8 Gy for multichannel. The dosimetric benefit of fractional re-planning was demonstrated: DVH analysis showed large, but not statistically significant differences between first fraction plan and fractional re-planning, due to large inter-fraction variations for rectum and bladder positioning and filling.ConclusionsVaginal HDR brachytherapy using a multichannel vaginal applicator and inverse planning provides dosimetric advantages over single channel cylinder, by reducing the dose to organs at risk without compromising the target volume coverage, but at the expense of an increased vaginal mucosa dose. Due to large inter-fraction dose variations, we recommend individual fraction treatment plan optimization.

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What Causes Vaginal Stenosis in Patients Undergoing Adjuvant Intracavitary Brachytherapy for Endometrial Cancer?

Cited by 2 publications

References 0 publications

High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma

High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma

Single versus multichannel applicator in high-dose-rate vaginal brachytherapy optimized by inverse treatment planning

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