title: Evaluation of morbidity after external radiotherapy and intracavitary brachytherapy in 771 patients with carcinoma of the uterine cervix or endometrium.
abstract: OBJECTIVE
  The aim of the present study was to evaluate early and late radiation morbidity and to assess the factors influencing morbidity in patients with cervical or endometrial cancer treated by a combination of external radiotherapy (ERT) and intracavitary brachytherapy (IBRT).
  
  
  METHODS
  Early and late radiation morbidity were evaluated retrospectively using RTOG/EORTC criteria and Franco-Italian glossary in 771 patients treated between November 1992 and December 1999.
  
  
  RESULTS
  Four hundred and seven patients (52.8%) had endometrial carcinoma and 364 (47.2%) had carcinoma of the cervix. One hundred and fifty-four patients with cervical carcinoma were inoperable. In patients with endometrial carcinoma total doses at the vagina, bladder and rectum were 60.36 Gy, 56.2 Gy and 55.6 Gy respectively. Biologically equivalent doses (BED) for the same points were 79.35, 68.63 and 67.37, respectively for early effects and 123.67, 97.65 and 94.85, respectively for late effects. One hundred and sixty-nine patients (41.5%) developed acute morbidity, grade I and II bladder morbidity being the most common type and 85 patients (20.9%) developed late morbidity, grade I and II vaginal morbidity being the most common type. No grade IV morbidity was recorded. Total doses at the vagina, bladder and rectum in operated cervix cancer patients were 60.51 Gy, 56.53 Gy and 55.67 Gy, respectively. BED for the same points were 79.77, 69.36 and 67.52, respectively for early effects and 124.74, 99.3 and 95.17, respectively for late effects. Eighty patients (38.1%) developed early morbidity. Grade I and II bladder morbidity was the most common type. Sixty-five patients (30.9%) developed late morbidity, vaginal morbidity being the most common type. Total doses at the vagina, bladder and rectum in inoperable patients were 70.92 Gy, 66.71 Gy and 62.38 Gy, respectively. BED for the same points were 97.43, 89.64 and 81.63, respectively for early effects and 159.3, 143.16 and 126.56, respectively for late effects. Sixty patients (39%) developed acute morbidity which was grade I or II bladder morbidity in 95%. Ninety-five patients (61.7%) developed late morbidity which was grade I-III vaginal morbidity in 94%.
  
  
  CONCLUSIONS
  Patients with cervical or endometrial cancer can be treated safely by a combination of ERT and IBRT. However the patients should be assessed before, during and after treatment and at every period of follow-up using a standard and well-defined system in order to define and predict the morbidity rate.
authors.affiliation: Ege University, Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey.
authors.forename: D
authors.initials: D
authors.lastname: Yalman
authors.forename: A
authors.initials: A
authors.lastname: Arican
authors.forename: Z
authors.initials: Z
authors.lastname: Ozsaran
authors.forename: O K
authors.initials: OK
authors.lastname: Celik
authors.forename: V
authors.initials: V
authors.lastname: Yürüt
authors.forename: M
authors.initials: M
authors.lastname: Esassolak
authors.forename: A
authors.initials: A
authors.lastname: Haydaroglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002277:Carcinoma / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D003556:Cystitis / Q000209:etiology; D016889:Endometrial Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011336:Probability; D011349:Proctitis / Q000209:etiology; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D014594:Uterine Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D014627:Vaginitis / Q000209:etiology