Importance of the ICRU bladder point dose on incidence and persistence of urinary frequency and incontinence in locally advanced cervical cancer: An EMBRACE analysis

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Sofia Spampinato
  • Lars U. Fokdal
  • Richard Pötter, Medical University of Vienna
  • ,
  • Christine Haie-Meder, Institut Gustave Roussy
  • ,
  • Jacob C. Lindegaard
  • Maximilian P. Schmid, Medical University of Vienna
  • ,
  • Alina Sturdza, Medical University of Vienna
  • ,
  • Ina M. Jürgenliemk-Schulz, Utrecht University
  • ,
  • Umesh Mahantshetty, Tata Memorial Hospital
  • ,
  • Barbara Segedin, Institute of Oncology Ljubljana
  • ,
  • Kjersti Bruheim, University of Oslo
  • ,
  • Peter Hoskin, Mount Vernon Hospital
  • ,
  • Bhavana Rai, Chandigarh University
  • ,
  • Fleur Huang, University of Alberta
  • ,
  • Rachel Cooper, Leeds Teaching Hospitals NHS Trust
  • ,
  • Elzbieta van der Steen-Banasik, Radiotherapiegroep Arnhem
  • ,
  • Erik Van Limbergen, KU Leuven
  • ,
  • Marit Sundset, St Olavs Hospital, Trondheim University Hospital
  • ,
  • Henrike Westerveld, University of Amsterdam
  • ,
  • Remi A. Nout, Leiden University
  • ,
  • Nina B.K. Jensen
  • Christian Kirisits, Medical University of Vienna
  • ,
  • Kathrin Kirchheiner, Medical University of Vienna
  • ,
  • Kari Tanderup
  • EMBRACE Collaborative Group1

Purpose: To identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methods: Physician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC “very much” and “quite a bit” or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ “quite a bit” were scored in at least half of follow-ups. Results: Longitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D2cm3. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose. Conclusion: ICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose–effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes.

OriginalsprogEngelsk
TidsskriftRadiotherapy and Oncology
Vol/bind158
Sider (fra-til)300-308
Antal sider9
ISSN0167-8140
DOI
StatusUdgivet - maj 2021

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