title: Dosimetric factors predicting severe radiation-induced bowel complications in patients with cervical cancer: combined effect of external parametrial dose and cumulative rectal dose.
abstract: OBJECTIVE
  The purpose of this study was to analyze dosimetric factors of radiation-induced severe bowel complications among patients with cervical cancer.
  
  
  METHODS
  We reviewed 297 patients of stage IB-IVA cervical cancer managed by curative-intent radiotherapy from May 1993 through December 1997. Whole-pelvic irradiation of external beam radiation therapy (EBRT) (34.2-48.6 Gy/19-27 fractions) was delivered to all patients. Two hundred and three patients received additional bilateral parametrial boost (3.6-18 Gy/2-10 fractions). High dose-rate (HDR) intracavitary brachytherapy (ICBT), 16-24 Gy/5 fractions to Point A, was given after external irradiation. Cumulative rectal biologically effective dose (CRBED) at rectal reference point was determined by summation of EBRT and ICBT component.
  
  
  RESULTS
  The 5-year incidences of Grade 3-4 enterocolitis and proctitis were 10% and 7%, respectively. Both complications were associated with external parametrial dose (PMD) and CRBED. Interaction of CRBED and PMD was noted in multivariate analysis of enterocolitis (P < 0.001) and proctitis (P < 0.001). In CRBED > or = 100 Gy(3) group, PMD was an independent factor in enterocolitis (P = 0.010) and proctitis (P = 0.039). In PMD > or = 54 Gy group, CRBED was an independent factor in enterocolitis (P = 0.003) and proctitis (P = 0.036). Patients with both PMD > or = 54 Gy and CRBED > or = 100 Gy(3) had higher incidence of 5-year enterocolitis (26%) (P < 0.001) and proctitis (17%) (P < 0.001) than other dose groups.
  
  
  CONCLUSIONS
  Radiation-induced severe bowel complications are association on both high PMD and high CRBED. We do not suggest both external PMD > or = 54 Gy and CRBED > or = 100 Gy(3) for treatment of cervical cancer due to unacceptably high incidence of severe bowel complications.
authors.affiliation: Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan. engyen@med-assn.org.tw
authors.forename: Eng-Yen
authors.initials: EY
authors.lastname: Huang
authors.forename: Chong-Jong
authors.initials: CJ
authors.lastname: Wang
authors.forename: Hsuan-Chih
authors.initials: HC
authors.lastname: Hsu
authors.lastname: Hao Lin
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004307:Dose-Response Relationship, Radiation; D004760:Enterocolitis / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011349:Proctitis / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology*; D011874:Radiometry; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*