PMID- 9069307
OWN - NLM
STAT- MEDLINE
DCOM- 19970331
LR  - 20190708
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 37
IP  - 2
DP  - 1997 Jan 15
TI  - Late rectal sequelae following definitive radiation therapy for carcinoma of the 
      uterine cervix: a dosimetric analysis.
PG  - 351-8
AB  - 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 were 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 patient 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 on 
      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.
FAU - Roeske, J C
AU  - Roeske JC
AD  - Department of Radiation and Cellular Oncology, University of Chicago Hospitals, 
      IL 60637, USA.
FAU - Mundt, A J
AU  - Mundt AJ
FAU - Halpern, H
AU  - Halpern H
FAU - Sweeney, P
AU  - Sweeney P
FAU - Sutton, H
AU  - Sutton H
FAU - Powers, C
AU  - Powers C
FAU - Rotmensch, J
AU  - Rotmensch J
FAU - Waggoner, S
AU  - Waggoner S
FAU - Weichselbaum, R R
AU  - Weichselbaum RR
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Dose-Response Relationship, Radiation
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Neoplasm Staging
MH  - Radiation Injuries/*etiology
MH  - Rectal Diseases/*etiology
MH  - Rectum/*radiation effects
MH  - Risk Factors
MH  - Uterine Cervical Neoplasms/pathology/*radiotherapy
EDAT- 1997/01/15 00:00
MHDA- 1997/01/15 00:01
CRDT- 1997/01/15 00:00
PHST- 1997/01/15 00:00 [pubmed]
PHST- 1997/01/15 00:01 [medline]
PHST- 1997/01/15 00:00 [entrez]
AID - S0360301696004907 [pii]
AID - 10.1016/s0360-3016(96)00490-7 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 1997 Jan 15;37(2):351-8. doi: 
      10.1016/s0360-3016(96)00490-7.