Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: A prospective analysis

• Y. Zhang ^[3] ; G. Gomez ^[4] ; C. Ascaso ^[1] ; A. Herreros ^[1] ; B. Fornes ^[2] ; J. Mases ^[2] ; J. Rochera ^[2] ; L. Tagliaferri ^[5] ; S. Sabater ^[6] ; A. Torne ^[2] ; A. Biete ^[1] ; Á. Rovirosa ^[1]
  1. [1] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
  2. [2] Hospital Clinic Barcelona

     Hospital Clinic Barcelona

     Barcelona, España

     
  3. [3] Cancer Center, Henan Provincial People’s Hospital, Zhengzhou, China
  4. [4] Radiation Oncology Dpt., Hospital Los Ángeles, Chihuahua, México
  5. [5] UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  6. [6] Radiation Oncology Dpt., Hospital General Universitario de Albacete, Albacete, Spain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 24, Nº. 5 (May), 2022, págs. 875-881
• Idioma: inglés
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  • Purpose To evaluate the preliminary results of the use of 68 Gy EQD2(α/β=3 Gy) as a dose limit to the lowest dose in the most exposed 2 cm3 of the vagina in order to reduce G2 late vaginal problems in postoperative endometrial carcinoma (EC).

    Methods From November 2016 to October 2019, 69 postoperative EC patients receiving vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) were prospectively analyzed. The median EBRT dose was 45 Gy (range: 44–50.4 Gy), 1.8−2 Gy/day, 5 fractions(Fr)/week. VBT was administered with the following schedule: 1Fr of 7 Gy after EBRT and 2 daily Fr × 7.5 Gy in exclusive VBT. The dose was prescribed at 0.5 cm from the applicator surface with an active length of 2.5 cm; 56 patients were treated with vaginal cylinders (49–3.5 cm, 6–3 cm, and 1–2.5 cm) and 13 with the colpostat technique. The overall VBT dose was adjusted to meet the vaginal restriction of < 68 Gy EQD2(α/β=3 Gy) at 2 cm3. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum, and the objective LENT-SOMA criteria for vagina.

    Results With a median follow-up of 31.0 months, no vaginal-cuff recurrences were found. Late toxicity: only 1G1(1.4%) rectal toxicity; 21G1(30.4%) and 3G2(4.3%) vaginal complications. Only one (1.4%) of 3 G2 manifested as vaginal shortening.

    Conclusions In postoperative EC patients treated with VBT, only one developed G2 vaginal stenosis with the use of 68 Gy EQD2(α/β=3 Gy) as a dose constraint. These preliminary results seem to indicate the value of this dose limit for reducing G2 vaginal stenosis. Nonetheless, these findings should be confirmed in a larger number of patients with longer follow-up.