Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for 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, Postgraduate Institute of Medical Education and Research
  • ,
  • Fleur Huang, University of Alberta
  • ,
  • Rachel Cooper, Leeds Teaching Hospitals NHS Trust
  • ,
  • Elzbieta van der Steen-Banasik, Radiotherapiegroep Arnhem
  • ,
  • Erik Van Limbergen, Radiation Oncology Department, Ghent University Hospital, Ghent
  • ,
  • Marit Sundset, Norwegian University of Science and Technology
  • ,
  • 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

Purpose: To identify patient- and treatment-related risk factors for fistula, bleeding, cystitis, pain and difficulty in voiding in locally advanced cervical cancer patients treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methods: Morbidity within the EMBRACE-I study was prospectively reported for physician-assessed (CTCAE) fistula, bleeding and cystitis and patient-reported (EORTC) pain and difficulty in voiding. Analysis of risk factors was performed in patients without bladder infiltration. Risk factors were tested with Cox regression for grade (G) ≥ 3 cystitis, for G ≥ 2 fistula, bleeding and cystitis, and for EORTC “very much” and “quite a bit” or worse. Results: Of 1416 patients enrolled, 1153 and 884 patients without bladder infiltration were evaluable for the analysis of CTCAE and EORTC items, respectively. Median follow-up was 48[3–120] months. Crude incidence rates for G ≥ 2 fistula, bleeding and cystitis were 0.7%, 2.7% and 8.8%, respectively, and 16% and 14% for ”quite a bit” or worse pain and difficulty in voiding, respectively. Baseline urinary morbidity and overweight/obesity were significant risk factors for most endpoints. Bladder D2cm3 correlated with G ≥ 2 fistula, bleeding and cystitis, while ICRU bladder point dose correlated with EORTC pain “quite a bit” or worse. An increase from 75 Gy to 80 Gy in bladder D2cm3 resulted in an increase from 8% to 13% for 4-year actuarial estimate of G ≥ 2 cystitis. Conclusion: Clinical and treatment-related risk factors for bladder fistula, bleeding and cystitis were identified within a prospective and multi-institutional setting. A dose–effect was established with bladder D2cm3, reinforcing the importance of continued optimization during individualized IGABT planning.

OriginalsprogEngelsk
TidsskriftRadiotherapy and Oncology
ISSN0167-8140
DOI
StatusAccepteret/In press - 2021

Se relationer på Aarhus Universitet Citationsformater

ID: 213102014