Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: A dosimetric analysis
Purpose : This study attempted to correlate patient, treatment, and dosimetric factors with the risk of late rectal sequelae in patients treated with radiation therapy (RT) for cervical carcinoma. Methods and Materials : A total of 183 patients with cervical carcinoma (67 Stage I, 93 Stage II, and 2...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 1997-01, Vol.37 (2), p.351-358 |
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| container_title | International journal of radiation oncology, biology, physics |
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| creator | Roeske, John C. Mundt, Arno J. Halpern, Howard Sweeney, Patrick Sutton, Harold Powers, Claire Rotmensch, Jacob Waggoner, Steve Weichselbaum, Ralph R. |
| description | Purpose
: This study attempted to correlate patient, treatment, and dosimetric factors with the risk of late rectal sequelae in patients treated with radiation therapy (RT) for cervical carcinoma.
Methods and Materials
: A total of 183 patients with cervical carcinoma (67 Stage I, 93 Stage II, and 23 Stage III) treated with definitive RT with a minimum of 2 years follow-up evaluated. Treatment consisted of external beam pelvic RT (EBRT) followed by intracavitary RT (ICRT) consisting of one or two insertions. Complications were scored and analyzed as a function of 25 patients and treatment factors. Conventional total rectal doses were obtained by adding together the EBRT and ICRT rectal doses. To account for differences in dose rate between the ICRT and EBRT, and variations in EBRT fractionation schemes, biologically equivalent rectal doses (BED) were calculated using a linear quadratic model. In addition, the influence of the varying proportions of EBRT and ICRT rectal doses were evaluated.
Results
: Twenty-eight patients (15.3%) developed late rectal sequelae (13 Grade 1, 3 Grade 2, and 12 Grade 3). Diabetes (
p = 0.03), Point A dose (
p = 0.04), and conventional EBRT dose (
p = 0.03) were the most significant factors ob multivariate analysis. Logistic regression analysis demonstrated a low risk ( |
| doi_str_mv | 10.1016/S0360-3016(96)00490-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_15929921</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0360301696004907</els_id><sourcerecordid>15929921</sourcerecordid><originalsourceid>FETCH-LOGICAL-c420t-4343fb5097254ccb095c6a2b2d77bf8875d239ea2d34594d97edddeff19c90c03</originalsourceid><addsrcrecordid>eNqFkcFuEzEQhi0EKmnhESr5gBAcltre9TrmUlUVhUqROBQkbpbXHsOgXTvYm0DeHqeJcu3JI_3fjMefCbnk7ANnvL96YG3PmraW73T_nrFOs0Y9Iwu-VLpppfzxnCxOyEtyXspvxhjnqjsjZ5r1umVqQbYrOwPN4GY70gJ_NjBaoCGNY_qL8Sf1EDDijNsKWY92xhTp_AuyXe8qlqmz2WFMk6Up7AO6mSFjBOogb_HfR3pDfSo4wZzRURvtuCtYXpEXwY4FXh_PC_L97tO32y_N6uvn-9ubVeM6weama7s2DJJpJWTn3MC0dL0Vg_BKDWG5VNKLVoMVvu2k7rxW4H1dOXDtNHOsvSBvD3PXOdW3ldlMWByMo42QNsVwqYXWgldQHkCXUykZgllnnGzeGc7M3rd59G32Mo3uzaNvo2rf5fGCzTCBP3UdBdf8zTG3xdkxZBsdlhMmeqEk7yt2fcCgytgiZFMcQnTgcf83xid8YpH_cTGejA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>15929921</pqid></control><display><type>article</type><title>Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: A dosimetric analysis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Roeske, John C. ; Mundt, Arno J. ; Halpern, Howard ; Sweeney, Patrick ; Sutton, Harold ; Powers, Claire ; Rotmensch, Jacob ; Waggoner, Steve ; Weichselbaum, Ralph R.</creator><creatorcontrib>Roeske, John C. ; Mundt, Arno J. ; Halpern, Howard ; Sweeney, Patrick ; Sutton, Harold ; Powers, Claire ; Rotmensch, Jacob ; Waggoner, Steve ; Weichselbaum, Ralph R.</creatorcontrib><description>Purpose
: This study attempted to correlate patient, treatment, and dosimetric factors with the risk of late rectal sequelae in patients treated with radiation therapy (RT) for cervical carcinoma.
Methods and Materials
: A total of 183 patients with cervical carcinoma (67 Stage I, 93 Stage II, and 23 Stage III) treated with definitive RT with a minimum of 2 years follow-up evaluated. Treatment consisted of external beam pelvic RT (EBRT) followed by intracavitary RT (ICRT) consisting of one or two insertions. Complications were scored and analyzed as a function of 25 patients and treatment factors. Conventional total rectal doses were obtained by adding together the EBRT and ICRT rectal doses. To account for differences in dose rate between the ICRT and EBRT, and variations in EBRT fractionation schemes, biologically equivalent rectal doses (BED) were calculated using a linear quadratic model. In addition, the influence of the varying proportions of EBRT and ICRT rectal doses were evaluated.
Results
: Twenty-eight patients (15.3%) developed late rectal sequelae (13 Grade 1, 3 Grade 2, and 12 Grade 3). Diabetes (
p = 0.03), Point A dose (
p = 0.04), and conventional EBRT dose (
p = 0.03) were the most significant factors ob multivariate analysis. Logistic regression analysis demonstrated a low risk (<10%) of late rectal sequelae below conventional and biological rectal doses of 75 Gy and 135 BED, respectively. The percentage of rectal dose delivered by the EBRT significantly influenced the dose-response relationship. A defined threshold percentage above which rectal sequelae were more common was identified over the range of doses evaluated. This threshold was 87% at a total rectal dose of 60 Gy and decreased to 60% at 80 Gy.
Conclusion
: Diabetes, Point A, and EBRT doses are the most significant factors associated with the risk of late rectal sequelae in patients treated with RT for cervical carcinoma. The percentage of rectal dose delivered by the EBRT significantly affects the conventional and biological dose-response relationship. This suggests that the volume of rectum irradiated is an important and independent parameter in the development of late rectal sequelae.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/S0360-3016(96)00490-7</identifier><identifier>PMID: 9069307</identifier><identifier>CODEN: IOBPD3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cervix carcinoma ; Dose-Response Relationship, Radiation ; Female ; Female genital diseases ; Gynecology. Andrology. Obstetrics ; Humans ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Radiation Injuries - etiology ; Radiation therapy ; Rectal complications ; Rectal Diseases - etiology ; Rectum - radiation effects ; Risk Factors ; Tumors ; Uterine Cervical Neoplasms - pathology ; Uterine Cervical Neoplasms - radiotherapy</subject><ispartof>International journal of radiation oncology, biology, physics, 1997-01, Vol.37 (2), p.351-358</ispartof><rights>1997</rights><rights>1997 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-4343fb5097254ccb095c6a2b2d77bf8875d239ea2d34594d97edddeff19c90c03</citedby><cites>FETCH-LOGICAL-c420t-4343fb5097254ccb095c6a2b2d77bf8875d239ea2d34594d97edddeff19c90c03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301696004907$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>309,310,314,776,780,785,786,3537,23909,23910,25118,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2627516$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9069307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roeske, John C.</creatorcontrib><creatorcontrib>Mundt, Arno J.</creatorcontrib><creatorcontrib>Halpern, Howard</creatorcontrib><creatorcontrib>Sweeney, Patrick</creatorcontrib><creatorcontrib>Sutton, Harold</creatorcontrib><creatorcontrib>Powers, Claire</creatorcontrib><creatorcontrib>Rotmensch, Jacob</creatorcontrib><creatorcontrib>Waggoner, Steve</creatorcontrib><creatorcontrib>Weichselbaum, Ralph R.</creatorcontrib><title>Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: A dosimetric analysis</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose
: This study attempted to correlate patient, treatment, and dosimetric factors with the risk of late rectal sequelae in patients treated with radiation therapy (RT) for cervical carcinoma.
Methods and Materials
: A total of 183 patients with cervical carcinoma (67 Stage I, 93 Stage II, and 23 Stage III) treated with definitive RT with a minimum of 2 years follow-up evaluated. Treatment consisted of external beam pelvic RT (EBRT) followed by intracavitary RT (ICRT) consisting of one or two insertions. Complications were scored and analyzed as a function of 25 patients and treatment factors. Conventional total rectal doses were obtained by adding together the EBRT and ICRT rectal doses. To account for differences in dose rate between the ICRT and EBRT, and variations in EBRT fractionation schemes, biologically equivalent rectal doses (BED) were calculated using a linear quadratic model. In addition, the influence of the varying proportions of EBRT and ICRT rectal doses were evaluated.
Results
: Twenty-eight patients (15.3%) developed late rectal sequelae (13 Grade 1, 3 Grade 2, and 12 Grade 3). Diabetes (
p = 0.03), Point A dose (
p = 0.04), and conventional EBRT dose (
p = 0.03) were the most significant factors ob multivariate analysis. Logistic regression analysis demonstrated a low risk (<10%) of late rectal sequelae below conventional and biological rectal doses of 75 Gy and 135 BED, respectively. The percentage of rectal dose delivered by the EBRT significantly influenced the dose-response relationship. A defined threshold percentage above which rectal sequelae were more common was identified over the range of doses evaluated. This threshold was 87% at a total rectal dose of 60 Gy and decreased to 60% at 80 Gy.
Conclusion
: Diabetes, Point A, and EBRT doses are the most significant factors associated with the risk of late rectal sequelae in patients treated with RT for cervical carcinoma. The percentage of rectal dose delivered by the EBRT significantly affects the conventional and biological dose-response relationship. This suggests that the volume of rectum irradiated is an important and independent parameter in the development of late rectal sequelae.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cervix carcinoma</subject><subject>Dose-Response Relationship, Radiation</subject><subject>Female</subject><subject>Female genital diseases</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging</subject><subject>Radiation Injuries - etiology</subject><subject>Radiation therapy</subject><subject>Rectal complications</subject><subject>Rectal Diseases - etiology</subject><subject>Rectum - radiation effects</subject><subject>Risk Factors</subject><subject>Tumors</subject><subject>Uterine Cervical Neoplasms - pathology</subject><subject>Uterine Cervical Neoplasms - radiotherapy</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFuEzEQhi0EKmnhESr5gBAcltre9TrmUlUVhUqROBQkbpbXHsOgXTvYm0DeHqeJcu3JI_3fjMefCbnk7ANnvL96YG3PmraW73T_nrFOs0Y9Iwu-VLpppfzxnCxOyEtyXspvxhjnqjsjZ5r1umVqQbYrOwPN4GY70gJ_NjBaoCGNY_qL8Sf1EDDijNsKWY92xhTp_AuyXe8qlqmz2WFMk6Up7AO6mSFjBOogb_HfR3pDfSo4wZzRURvtuCtYXpEXwY4FXh_PC_L97tO32y_N6uvn-9ubVeM6weama7s2DJJpJWTn3MC0dL0Vg_BKDWG5VNKLVoMVvu2k7rxW4H1dOXDtNHOsvSBvD3PXOdW3ldlMWByMo42QNsVwqYXWgldQHkCXUykZgllnnGzeGc7M3rd59G32Mo3uzaNvo2rf5fGCzTCBP3UdBdf8zTG3xdkxZBsdlhMmeqEk7yt2fcCgytgiZFMcQnTgcf83xid8YpH_cTGejA</recordid><startdate>19970115</startdate><enddate>19970115</enddate><creator>Roeske, John C.</creator><creator>Mundt, Arno J.</creator><creator>Halpern, Howard</creator><creator>Sweeney, Patrick</creator><creator>Sutton, Harold</creator><creator>Powers, Claire</creator><creator>Rotmensch, Jacob</creator><creator>Waggoner, Steve</creator><creator>Weichselbaum, Ralph R.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope></search><sort><creationdate>19970115</creationdate><title>Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: A dosimetric analysis</title><author>Roeske, John C. ; Mundt, Arno J. ; Halpern, Howard ; Sweeney, Patrick ; Sutton, Harold ; Powers, Claire ; Rotmensch, Jacob ; Waggoner, Steve ; Weichselbaum, Ralph R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c420t-4343fb5097254ccb095c6a2b2d77bf8875d239ea2d34594d97edddeff19c90c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cervix carcinoma</topic><topic>Dose-Response Relationship, Radiation</topic><topic>Female</topic><topic>Female genital diseases</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging</topic><topic>Radiation Injuries - etiology</topic><topic>Radiation therapy</topic><topic>Rectal complications</topic><topic>Rectal Diseases - etiology</topic><topic>Rectum - radiation effects</topic><topic>Risk Factors</topic><topic>Tumors</topic><topic>Uterine Cervical Neoplasms - pathology</topic><topic>Uterine Cervical Neoplasms - radiotherapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roeske, John C.</creatorcontrib><creatorcontrib>Mundt, Arno J.</creatorcontrib><creatorcontrib>Halpern, Howard</creatorcontrib><creatorcontrib>Sweeney, Patrick</creatorcontrib><creatorcontrib>Sutton, Harold</creatorcontrib><creatorcontrib>Powers, Claire</creatorcontrib><creatorcontrib>Rotmensch, Jacob</creatorcontrib><creatorcontrib>Waggoner, Steve</creatorcontrib><creatorcontrib>Weichselbaum, Ralph R.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roeske, John C.</au><au>Mundt, Arno J.</au><au>Halpern, Howard</au><au>Sweeney, Patrick</au><au>Sutton, Harold</au><au>Powers, Claire</au><au>Rotmensch, Jacob</au><au>Waggoner, Steve</au><au>Weichselbaum, Ralph R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: A dosimetric analysis</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>1997-01-15</date><risdate>1997</risdate><volume>37</volume><issue>2</issue><spage>351</spage><epage>358</epage><pages>351-358</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><coden>IOBPD3</coden><abstract>Purpose
: This study attempted to correlate patient, treatment, and dosimetric factors with the risk of late rectal sequelae in patients treated with radiation therapy (RT) for cervical carcinoma.
Methods and Materials
: A total of 183 patients with cervical carcinoma (67 Stage I, 93 Stage II, and 23 Stage III) treated with definitive RT with a minimum of 2 years follow-up evaluated. Treatment consisted of external beam pelvic RT (EBRT) followed by intracavitary RT (ICRT) consisting of one or two insertions. Complications were scored and analyzed as a function of 25 patients and treatment factors. Conventional total rectal doses were obtained by adding together the EBRT and ICRT rectal doses. To account for differences in dose rate between the ICRT and EBRT, and variations in EBRT fractionation schemes, biologically equivalent rectal doses (BED) were calculated using a linear quadratic model. In addition, the influence of the varying proportions of EBRT and ICRT rectal doses were evaluated.
Results
: Twenty-eight patients (15.3%) developed late rectal sequelae (13 Grade 1, 3 Grade 2, and 12 Grade 3). Diabetes (
p = 0.03), Point A dose (
p = 0.04), and conventional EBRT dose (
p = 0.03) were the most significant factors ob multivariate analysis. Logistic regression analysis demonstrated a low risk (<10%) of late rectal sequelae below conventional and biological rectal doses of 75 Gy and 135 BED, respectively. The percentage of rectal dose delivered by the EBRT significantly influenced the dose-response relationship. A defined threshold percentage above which rectal sequelae were more common was identified over the range of doses evaluated. This threshold was 87% at a total rectal dose of 60 Gy and decreased to 60% at 80 Gy.
Conclusion
: Diabetes, Point A, and EBRT doses are the most significant factors associated with the risk of late rectal sequelae in patients treated with RT for cervical carcinoma. The percentage of rectal dose delivered by the EBRT significantly affects the conventional and biological dose-response relationship. This suggests that the volume of rectum irradiated is an important and independent parameter in the development of late rectal sequelae.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9069307</pmid><doi>10.1016/S0360-3016(96)00490-7</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 0360-3016 |
| ispartof | International journal of radiation oncology, biology, physics, 1997-01, Vol.37 (2), p.351-358 |
| issn | 0360-3016 1879-355X |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cervix carcinoma Dose-Response Relationship, Radiation Female Female genital diseases Gynecology. Andrology. Obstetrics Humans Medical sciences Middle Aged Multivariate Analysis Neoplasm Staging Radiation Injuries - etiology Radiation therapy Rectal complications Rectal Diseases - etiology Rectum - radiation effects Risk Factors Tumors Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - radiotherapy |
| title | Late rectal sequelae following definitive radiation therapy for carcinoma of the uterine cervix: A dosimetric analysis |
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