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De-escalation of the cumulative central radiation dose according to the tumor response can reduce rectal toxicity without compromising the treatment outcome in patients with uterine cervical cancer

 Kyung Hwan Kim  ;  Sunghoon Kim  ;  Gwi Eon Kim  ;  Woong Sub Koom  ;  SangWun Kim  ;  Eun Ji Nam  ;  Chang-Ok Suh  ;  Yong Bae Kim 
 GYNECOLOGIC ONCOLOGY, Vol.139(3) : 439-446, 2015 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Brachytherapy/adverse effects ; Brachytherapy/methods ; Carcinoma/radiotherapy* ; Carcinoma/secondary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Radiation Injuries/etiology ; Radiation Injuries/prevention & control* ; Radiotherapy/adverse effects* ; Radiotherapy/methods* ; Radiotherapy Dosage ; Rectum/radiation effects* ; Retrospective Studies ; Survival Rate ; Time Factors ; Urinary Bladder/radiation effects ; Uterine Cervical Neoplasms/pathology ; Uterine Cervical Neoplasms/radiotherapy* ; Young Adult
Midline block ; Radiotherapy ; Toxicity ; Uterine cervical cancer
OBJECTIVE: To assess the treatment outcome and toxicity of a low cumulative central dose using a midline block (MLB) during external beam radiotherapy (EBRT).

METHODS: Between January 1988 and December 2010, 1559 patients with FIGO stage IB-IIB uterine cervical cancer that underwent EBRT and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were retrospectively analyzed. During EBRT, MLB was performed (n=1195, MLB group) when a sufficient response was achieved to insert the tandem through the cervical canal and place ovoids in the vaginal cavity. MLB was not applied for patients with a slow tumor response (n=364, non-MLB group). The doses were estimated according to the International Commission on Radiation Units and Measurements (ICRU) points. The biologically equivalent dose in 2-Gy fractions (EQD2) was calculated to estimate the cumulative dose from EBRT and ICBT.

RESULTS: EQD2pointA, EQD2rectum, and EQD2bladder were all significantly lower in the MLB group (all P<0.05). The 10-year grade≥2 late rectal toxicity rate was significantly lower in the MLB group (P=0.012), while there was no significant difference in late genitourinary and small bowel toxicity. ICRU rectal and bladder doses showed significant predictability on late rectal and bladder toxicities. After propensity score matching, all patient and tumor characteristics were well matched and the survival and recurrence rates between the two groups were similar (all P>0.05), despite the lower EQD2pointA in the MLB group (P<0.001).

CONCLUSIONS: Applying MLB according to tumor response during EBRT lowered the cumulative central dose and reduced late rectal toxicity without compromising treatment outcome.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Kyung Hwan(김경환)
Kim, Sang Wun(김상운) ORCID logo https://orcid.org/0000-0002-8342-8701
Kim, Sung Hoon(김성훈) ORCID logo https://orcid.org/0000-0002-1645-7473
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Nam, Eun Ji(남은지) ORCID logo https://orcid.org/0000-0003-0189-3560
Suh, Chang Ok(서창옥)
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