Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?

• Yaowen Zhang ^[2] ; Faegheh Noorian ^[3] ; Rosa Abellana ^[1] ; José Rochera ^[3] ; Antonio Herreros ^[3] ; Gabriela Antelo ^[3] ; Valentina Lancellotta ^[4] ; Luca Tagliaferri ^[4] ; Qian Han ^[2] ; Aureli Torne ^[5] ; Angeles Rovirosa ^[3]
  1. [1] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
  2. [2] Cancer Center, Henan Provincial People’s Hospital, Zhengzhou, China
  3. [3] Radiation Oncology Department, Hospital Clínic-Universitat de Barcelona
  4. [4] Dipartimento di Diagnostica per Immagini, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
  5. [5] Gynecological Cancer Unit, Hospital Clinic-Universitat de Barcelona

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 25, Nº. 6, 2023, págs. 1748-1755
• Idioma: inglés
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• Resumen

  • Purpose Analyse the impact of different prognostic factors on G2-late vaginal complications after vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) in postoperative endometrial cancer (PEC).

    Methods One hundred and twenty-six PEC patients treated with VBT ± EBRT were retrospectively analysed considering age, body mass index, applicator diameter, clinical target volume (CTV), use of dilators, chemotherapy and EQD2(α/β=3) at the most exposed 2 cm3 of the CTV as prognostic factors for vaginal complications. Late vaginal complications were evaluated using objective LENT-SOMA criteria. Statistics: descriptive analysis, Chi-square, Fisher and Student tests were applied. Univariate and multivariate analyses were performed with the Baptista–Pike exact method and multiple logistic regression.

    Results Mean age was 65 years (SD ± 10), and median follow-up was 66 months (8–104). 19/126 patients (15%) showed G2-late vaginal complications, and 107/126 (85%) G0–G1. Univariate analysis showed: CTV ≤ 9 cm3 (p = 0.036), use of dilators < 9 months (p = 0.015), and total ≥ 68 Gy EQD2 received by 2 cm3 of CTV (p = 0.039) were associated with G2-late vaginal toxicity. Multivariate analysis showed the use of dilators < 9 months as an independent prognostic factor for G2-late vaginal toxicity (p = 0.043, OR 8.59, CI 1.59–159.9).

    Conclusion The use of dilators < 9 months in VBT ± EBRT for PEC was an independent prognostic factor for G2-late vaginal toxicity. The use of vaginal dilators ≥ 9 months requires further analysis in studies evaluating late vaginal toxicity.