Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy
Identifieur interne : 001908 ( Istex/Corpus ); précédent : 001907; suivant : 001909Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy
Auteurs : Karin S. Kapp ; Georg F. Stuecklschweiger ; Daniel S. Kapp ; Johann Poschauko ; Hellmuth Pickel ; Arnulf HacklSource :
- Radiotherapy and Oncology [ 0167-8140 ] ; 1997.
Abstract
Background and purpose: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This retrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. Material and methods: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB–IVB) received EBR to the pelvis (ave. max. dose 48.8 Gy) followed by 1–6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). Results: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P=0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. Conclusion: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.
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DOI: 10.1016/S0167-8140(96)01881-6
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title><author><name sortKey="Kapp, Karin S" sort="Kapp, Karin S" uniqKey="Kapp K" first="Karin S" last="Kapp">Karin S. Kapp</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Stuecklschweiger, Georg F" sort="Stuecklschweiger, Georg F" uniqKey="Stuecklschweiger G" first="Georg F" last="Stuecklschweiger">Georg F. Stuecklschweiger</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Kapp, Daniel S" sort="Kapp, Daniel S" uniqKey="Kapp D" first="Daniel S" last="Kapp">Daniel S. Kapp</name><affiliation><mods:affiliation>Department of Radiation Oncology, Stanford University Medical School, Stanford University, Stanford, CA 94305, USA</mods:affiliation></affiliation></author><author><name sortKey="Poschauko, Johann" sort="Poschauko, Johann" uniqKey="Poschauko J" first="Johann" last="Poschauko">Johann Poschauko</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Pickel, Hellmuth" sort="Pickel, Hellmuth" uniqKey="Pickel H" first="Hellmuth" last="Pickel">Hellmuth Pickel</name><affiliation><mods:affiliation>Division of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Auenbruggerplatz 14, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Hackl, Arnulf" sort="Hackl, Arnulf" uniqKey="Hackl A" first="Arnulf" last="Hackl">Arnulf Hackl</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394</idno><date when="1997" year="1997">1997</date><idno type="doi">10.1016/S0167-8140(96)01881-6</idno><idno type="url">https://api.istex.fr/document/3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001908</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001908</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title><author><name sortKey="Kapp, Karin S" sort="Kapp, Karin S" uniqKey="Kapp K" first="Karin S" last="Kapp">Karin S. Kapp</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Stuecklschweiger, Georg F" sort="Stuecklschweiger, Georg F" uniqKey="Stuecklschweiger G" first="Georg F" last="Stuecklschweiger">Georg F. Stuecklschweiger</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Kapp, Daniel S" sort="Kapp, Daniel S" uniqKey="Kapp D" first="Daniel S" last="Kapp">Daniel S. Kapp</name><affiliation><mods:affiliation>Department of Radiation Oncology, Stanford University Medical School, Stanford University, Stanford, CA 94305, USA</mods:affiliation></affiliation></author><author><name sortKey="Poschauko, Johann" sort="Poschauko, Johann" uniqKey="Poschauko J" first="Johann" last="Poschauko">Johann Poschauko</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Pickel, Hellmuth" sort="Pickel, Hellmuth" uniqKey="Pickel H" first="Hellmuth" last="Pickel">Hellmuth Pickel</name><affiliation><mods:affiliation>Division of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Auenbruggerplatz 14, A-8036 Graz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Hackl, Arnulf" sort="Hackl, Arnulf" uniqKey="Hackl A" first="Arnulf" last="Hackl">Arnulf Hackl</name><affiliation><mods:affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Radiotherapy and Oncology</title><title level="j" type="abbrev">RADION</title><idno type="ISSN">0167-8140</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">42</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="143">143</biblScope><biblScope unit="page" to="153">153</biblScope></imprint><idno type="ISSN">0167-8140</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0167-8140</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and purpose: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This retrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. Material and methods: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB–IVB) received EBR to the pelvis (ave. max. dose 48.8 Gy) followed by 1–6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). Results: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P=0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. Conclusion: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>cervix</json:string><json:string>bladder</json:string><json:string>oncol</json:string><json:string>brachytherapy</json:string><json:string>radiat</json:string><json:string>biol</json:string><json:string>phys</json:string><json:string>rectal</json:string><json:string>uterine</json:string><json:string>bowel</json:string><json:string>carcinoma</json:string><json:string>radiotherapy</json:string><json:string>dos</json:string><json:string>oncology</json:string><json:string>uterine cervix</json:string><json:string>sequela</json:string><json:string>rectum</json:string><json:string>kapp</json:string><json:string>complication</json:string><json:string>intracavitary</json:string><json:string>late complications</json:string><json:string>cumrd</json:string><json:string>maximum doses</json:string><json:string>figo</json:string><json:string>median</json:string><json:string>pretreatment</json:string><json:string>genitourinary</json:string><json:string>afterloading</json:string><json:string>radiation therapy</json:string><json:string>normal tissue</json:string><json:string>complication rates</json:string><json:string>dose rate</json:string><json:string>toxicity</json:string><json:string>anterior rectal wall</json:string><json:string>high dose rate brachytherapy</json:string><json:string>genitourinary tract complications</json:string><json:string>external beam radiation</json:string><json:string>total dose</json:string><json:string>bladder base</json:string><json:string>pelvis</json:string><json:string>actuarial</json:string><json:string>late damage</json:string><json:string>cumulative dose</json:string><json:string>treatment parameters</json:string><json:string>bladder neck</json:string><json:string>multivariate analysis</json:string><json:string>radiation oncology</json:string><json:string>persistent symptoms</json:string><json:string>cervical carcinoma</json:string><json:string>severe complications</json:string><json:string>range months</json:string><json:string>late sequelae</json:string><json:string>dose</json:string><json:string>applicator</json:string><json:string>coexisting factors</json:string><json:string>major complications</json:string><json:string>vaginal ulcers</json:string><json:string>treatment planning</json:string><json:string>university clinic</json:string><json:string>severe sequelae</json:string><json:string>daily dose fraction</json:string><json:string>figo stage</json:string><json:string>actuarial rates</json:string><json:string>overall incidence</json:string></teeft></keywords><author><json:item><name>Karin S Kapp</name><affiliations><json:string>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</json:string></affiliations></json:item><json:item><name>Georg F Stuecklschweiger</name><affiliations><json:string>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</json:string></affiliations></json:item><json:item><name>Daniel S Kapp</name><affiliations><json:string>Department of Radiation Oncology, Stanford University Medical School, Stanford University, Stanford, CA 94305, USA</json:string></affiliations></json:item><json:item><name>Johann Poschauko</name><affiliations><json:string>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</json:string></affiliations></json:item><json:item><name>Hellmuth Pickel</name><affiliations><json:string>Division of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Auenbruggerplatz 14, A-8036 Graz, Austria</json:string></affiliations></json:item><json:item><name>Arnulf Hackl</name><affiliations><json:string>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>High dose rate brachytherapy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Cervical carcinoma</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Late complications</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Prognostic factors</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Background and purpose: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This retrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. Material and methods: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB–IVB) received EBR to the pelvis (ave. max. dose 48.8 Gy) followed by 1–6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). Results: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P=0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. Conclusion: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.</abstract><qualityIndicators><score>8</score><pdfVersion>1.1</pdfVersion><pdfPageSize>593 x 793 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>2382</abstractCharCount><pdfWordCount>6789</pdfWordCount><pdfCharCount>44160</pdfCharCount><pdfPageCount>11</pdfPageCount><abstractWordCount>356</abstractWordCount></qualityIndicators><title>Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title><pii><json:string>S0167-8140(96)01881-6</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>Radiotherapy and Oncology</title><language><json:string>unknown</json:string></language><publicationDate>1997</publicationDate><issn><json:string>0167-8140</json:string></issn><pii><json:string>S0167-8140(00)X0026-6</json:string></pii><volume>42</volume><issue>2</issue><pages><first>143</first><last>153</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>radiology, nuclear medicine & medical imaging</json:string><json:string>oncology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>oncology & carcinogenesis</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>1997</publicationDate><copyrightDate>1997</copyrightDate><doi><json:string>10.1016/S0167-8140(96)01881-6</json:string></doi><id>3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1997 Elsevier Science Ireland Ltd</p></availability><date>1997</date></publicationStmt><notesStmt><note>Presented in part at the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Miami Beach, Florida, October 8–11, 1995.</note><note type="content">Fig. 1: Total number of Ir-192 applications versus percentage of dose to bladder and rectum calculated at specified points on orthogonal films.</note><note type="content">Fig. 2: Actuarial rates of moderate and severe gastrointestinal complications in 161 patients.</note><note type="content">Fig. 3: Actuarial rates of moderate and severe genitourinary tract complications in 161 patients.</note><note type="content">Table 1: Tumor-associated parameters and follow-up by stage</note><note type="content">Table 2: Distribution of coexisting factors in 161 patients with primary carcinoma of the cervix</note><note type="content">Table 3: Definitions and grading of late complications</note><note type="content">Table 4: Moderate complications after EBR and HDR-ICP in 161 patients with carcinoma of the cervix</note><note type="content">Table 5: Severe complications after EBR and HDR-ICP in 161 patients with carcinoma of the cervix</note><note type="content">Table 6: Univariate analysis of pretreatment and treatment parameters in 161 patients with primary carcinoma of the cervix</note><note type="content">Table 7: HDR and institutional HDR versus LDR studies: complication rates and factors correlated with the incidence of major complications</note><note type="content">Table 8: LDR studies: complication rates and factors correlated with the incidence of major complications</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title><author xml:id="author-0000"><persName><forename type="first">Karin S</forename><surname>Kapp</surname></persName><note type="correspondence"><p>Corresponding author.</p></note><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Georg F</forename><surname>Stuecklschweiger</surname></persName><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Daniel S</forename><surname>Kapp</surname></persName><affiliation>Department of Radiation Oncology, Stanford University Medical School, Stanford University, Stanford, CA 94305, USA</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Johann</forename><surname>Poschauko</surname></persName><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Hellmuth</forename><surname>Pickel</surname></persName><affiliation>Division of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Auenbruggerplatz 14, A-8036 Graz, Austria</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Arnulf</forename><surname>Hackl</surname></persName><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation></author><idno type="istex">3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394</idno><idno type="DOI">10.1016/S0167-8140(96)01881-6</idno><idno type="PII">S0167-8140(96)01881-6</idno></analytic><monogr><title level="j">Radiotherapy and Oncology</title><title level="j" type="abbrev">RADION</title><idno type="pISSN">0167-8140</idno><idno type="PII">S0167-8140(00)X0026-6</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">42</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="143">143</biblScope><biblScope unit="page" to="153">153</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background and purpose: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This retrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. Material and methods: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB–IVB) received EBR to the pelvis (ave. max. dose 48.8 Gy) followed by 1–6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). Results: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P=0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. Conclusion: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>High dose rate brachytherapy</term></item><item><term>Cervical carcinoma</term></item><item><term>Late complications</term></item><item><term>Prognostic factors</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1996-10-30">Modified</change><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>RADION</jid><aid>1881</aid><ce:pii>S0167-8140(96)01881-6</ce:pii><ce:doi>10.1016/S0167-8140(96)01881-6</ce:doi><ce:copyright year="1997" type="full-transfer">Elsevier Science Ireland Ltd</ce:copyright></item-info><head><ce:title>Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy<ce:footnote id="FN1"><ce:label>1</ce:label><ce:note-para>Presented in part at the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Miami Beach, Florida, October 8–11, 1995.</ce:note-para></ce:footnote><ce:cross-ref refid="FN1"><ce:sup>1</ce:sup></ce:cross-ref></ce:title><ce:author-group><ce:author><ce:given-name>Karin S</ce:given-name><ce:surname>Kapp</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref><ce:cross-ref refid="CORR1">*</ce:cross-ref></ce:author><ce:author><ce:given-name>Georg F</ce:given-name><ce:surname>Stuecklschweiger</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref></ce:author><ce:author><ce:given-name>Daniel S</ce:given-name><ce:surname>Kapp</ce:surname><ce:cross-ref refid="AFF3">c</ce:cross-ref></ce:author><ce:author><ce:given-name>Johann</ce:given-name><ce:surname>Poschauko</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref></ce:author><ce:author><ce:given-name>Hellmuth</ce:given-name><ce:surname>Pickel</ce:surname><ce:cross-ref refid="AFF2">b</ce:cross-ref></ce:author><ce:author><ce:given-name>Arnulf</ce:given-name><ce:surname>Hackl</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Division of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Auenbruggerplatz 14, A-8036 Graz, Austria</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>Department of Radiation Oncology, Stanford University Medical School, Stanford University, Stanford, CA 94305, USA</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Corresponding author.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="9" month="2" year="1996"></ce:date-received><ce:date-revised day="30" month="10" year="1996"></ce:date-revised><ce:date-accepted day="27" month="11" year="1996"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:italic>Background and purpose</ce:italic>: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This retrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications.</ce:simple-para><ce:simple-para><ce:italic>Material and methods</ce:italic>: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB–IVB) received EBR to the pelvis (ave. max. dose 48.8 Gy) followed by 1–6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). <ce:vsp sp="1"></ce:vsp><ce:italic>Results</ce:italic>: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (<ce:italic>P</ce:italic>=0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae.</ce:simple-para><ce:simple-para><ce:italic>Conclusion</ce:italic>: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>High dose rate brachytherapy</ce:text></ce:keyword><ce:keyword><ce:text>Cervical carcinoma</ce:text></ce:keyword><ce:keyword><ce:text>Late complications</ce:text></ce:keyword><ce:keyword><ce:text>Prognostic factors</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy</title></titleInfo><name type="personal"><namePart type="given">Karin S</namePart><namePart type="family">Kapp</namePart><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation><description>Corresponding author.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Georg F</namePart><namePart type="family">Stuecklschweiger</namePart><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Daniel S</namePart><namePart type="family">Kapp</namePart><affiliation>Department of Radiation Oncology, Stanford University Medical School, Stanford University, Stanford, CA 94305, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Johann</namePart><namePart type="family">Poschauko</namePart><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hellmuth</namePart><namePart type="family">Pickel</namePart><affiliation>Division of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Auenbruggerplatz 14, A-8036 Graz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Arnulf</namePart><namePart type="family">Hackl</namePart><affiliation>Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Auenbruggerplatz 32, A-8036 Graz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><dateModified encoding="w3cdtf">1996-10-30</dateModified><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Background and purpose: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This retrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. Material and methods: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB–IVB) received EBR to the pelvis (ave. max. dose 48.8 Gy) followed by 1–6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). Results: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P=0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. Conclusion: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.</abstract><note type="footnote">Presented in part at the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Miami Beach, Florida, October 8–11, 1995.</note><note type="content">Fig. 1: Total number of Ir-192 applications versus percentage of dose to bladder and rectum calculated at specified points on orthogonal films.</note><note type="content">Fig. 2: Actuarial rates of moderate and severe gastrointestinal complications in 161 patients.</note><note type="content">Fig. 3: Actuarial rates of moderate and severe genitourinary tract complications in 161 patients.</note><note type="content">Table 1: Tumor-associated parameters and follow-up by stage</note><note type="content">Table 2: Distribution of coexisting factors in 161 patients with primary carcinoma of the cervix</note><note type="content">Table 3: Definitions and grading of late complications</note><note type="content">Table 4: Moderate complications after EBR and HDR-ICP in 161 patients with carcinoma of the cervix</note><note type="content">Table 5: Severe complications after EBR and HDR-ICP in 161 patients with carcinoma of the cervix</note><note type="content">Table 6: Univariate analysis of pretreatment and treatment parameters in 161 patients with primary carcinoma of the cervix</note><note type="content">Table 7: HDR and institutional HDR versus LDR studies: complication rates and factors correlated with the incidence of major complications</note><note type="content">Table 8: LDR studies: complication rates and factors correlated with the incidence of major complications</note><subject><genre>Keywords</genre><topic>High dose rate brachytherapy</topic><topic>Cervical carcinoma</topic><topic>Late complications</topic><topic>Prognostic factors</topic></subject><relatedItem type="host"><titleInfo><title>Radiotherapy and Oncology</title></titleInfo><titleInfo type="abbreviated"><title>RADION</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199703</dateIssued></originInfo><identifier type="ISSN">0167-8140</identifier><identifier type="PII">S0167-8140(00)X0026-6</identifier><part><date>199703</date><detail type="volume"><number>42</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue pages"><start>99</start><end>202</end></extent><extent unit="pages"><start>143</start><end>153</end></extent></part></relatedItem><identifier type="istex">3636D4942A15F4F4D39DD3CEDD2ABC1CF1E4E394</identifier><identifier type="DOI">10.1016/S0167-8140(96)01881-6</identifier><identifier type="PII">S0167-8140(96)01881-6</identifier><accessCondition type="use and reproduction" contentType="copyright">©1997 Elsevier Science Ireland Ltd</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science Ireland Ltd, ©1997</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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