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Effect of bladder volume on radiation doses to organs at risk and tumor in cervical cancer during image‑guided adaptive brachytherapy and treatment outcome analysis

  • Authors:
    • Zhiyuan Xu
    • Li Yang
    • Lingyu Ma
    • Qin Liu
    • Amy Ty Chang
    • Yong Zhou
    • Cheng Zhou
    • Feng-Ming Kong
    • Longhua Chen

  • View Affiliations

  • Published online on: October 15, 2021     https://doi.org/10.3892/mco.2021.2420
  • Article Number: 258

  • Copyright: © Xu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

There is no consensus in clinical practice on the optimal bladder volume during brachytherapy. The present study aimed to assess the effect of bladder volume on radiation dose to organs at risk and tumor in cervical cancer during image‑guided adaptive brachytherapy and clinical outcome. The retrospective study included patients treated at University of Hong Kong‑Shenzhen Hospital between January 2015 and July 2019. Patients with International Federation of Gynecology and Obstetrics (2009) stage IB1‑IVB (retroperitoneal lymph nodes metastasis only) cervical cancer treated by external beam radiotherapy with concurrent cisplatin followed by brachytherapy were assessed. A total of 421 brachytherapy insertions were analyzed. Every 83 and 90 cm3 (cc) increase in bladder volume led to an incremental raise of 1 Gy in bladder wall minimum dose received by the most irradiated 1 and 2 cc volumes (D1 and D2cc) of the bladder wall, respectively. An increase in bladder volume was associated with increased D1 and D2cc of bladder (both P<0.001, respectively) and rectal wall (P=0.150 and P=0.084, respectively), and decreased D1cc (P=0.003) and D2cc (P=0.001) of sigmoid wall, the maximum doses to the most minimally exposed 90 (D90) and 95% (D95) of the high risk‑clinical target volume (HR‑CTV; D90, P=0.010; D95, P=0.006). Patients with cumulative HR‑CTV D90≤89.6 Gy had shorter median overall survival (OS) than those with cumulative HR‑CTV D90>89.6 Gy (42.1 months vs. not reached, P=0.001). Patients with grade 2 acute urinary toxicity had significantly higher cumulative bladder wall D2cc than those with acute urinary toxicity<grade 2 (86.7±3.7 vs. 78.5±7.9 Gy; P=0.001). As the bladder volume increased, the dose to the bladder and rectal wall increase and dose to the sigmoid colon wall and HR‑CTV decrease based on intracavitary brachytherapy. The higher dose of HR‑CTV predicted better OS and the higher dose received by the bladder wall was associated with more grade 2 acute urinary toxicity.
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December-2021
Volume 15 Issue 6

Print ISSN: 2049-9450
Online ISSN:2049-9469

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  • CiteScore Rank: Q3: #250/404 Oncology
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Spandidos Publications style
Xu Z, Yang L, Ma L, Liu Q, Chang AT, Zhou Y, Zhou C, Kong F and Chen L: Effect of bladder volume on radiation doses to organs at risk and tumor in cervical cancer during image‑guided adaptive brachytherapy and treatment outcome analysis. Mol Clin Oncol 15: 258, 2021
APA
Xu, Z., Yang, L., Ma, L., Liu, Q., Chang, A.T., Zhou, Y. ... Chen, L. (2021). Effect of bladder volume on radiation doses to organs at risk and tumor in cervical cancer during image‑guided adaptive brachytherapy and treatment outcome analysis. Molecular and Clinical Oncology, 15, 258. https://doi.org/10.3892/mco.2021.2420
MLA
Xu, Z., Yang, L., Ma, L., Liu, Q., Chang, A. T., Zhou, Y., Zhou, C., Kong, F., Chen, L."Effect of bladder volume on radiation doses to organs at risk and tumor in cervical cancer during image‑guided adaptive brachytherapy and treatment outcome analysis". Molecular and Clinical Oncology 15.6 (2021): 258.
Chicago
Xu, Z., Yang, L., Ma, L., Liu, Q., Chang, A. T., Zhou, Y., Zhou, C., Kong, F., Chen, L."Effect of bladder volume on radiation doses to organs at risk and tumor in cervical cancer during image‑guided adaptive brachytherapy and treatment outcome analysis". Molecular and Clinical Oncology 15, no. 6 (2021): 258. https://doi.org/10.3892/mco.2021.2420