Dose-volume histogram predictors of chronic gastrointestinal complications after radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy for early-stage cervical cancer.
OBJECTIVE
The purpose of this study was to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in cervical cancer patients who underwent radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy.


METHODS
This study analyzed 97 patients who underwent postoperative concurrent chemoradiation therapy. The organs at risk that were contoured were the small bowel loops, large bowel loop, and peritoneal cavity. DVH parameters subjected to analysis included the volumes of these organs receiving more than 15, 30, 40, and 45 Gy (V15-V45) and their mean dose. Associations between DVH parameters or clinical factors and the incidence of grade 2 or higher chronic GI complications were evaluated.


RESULTS
Of the clinical factors, smoking and low body mass index (BMI) (<22) were significantly associated with grade 2 or higher chronic GI complications. Also, patients with chronic GI complications had significantly greater V15-V45 volumes and higher mean dose of the small bowel loops compared with those without GI complications. In contrast, no parameters for the large bowel loop or peritoneal cavity were significantly associated with GI complications. Results of the receiver operating characteristics (ROC) curve analysis led to the conclusion that V15-V45 of the small bowel loops has high accuracy for prediction of GI complications. Among these parameters, V40 gave the highest area under the ROC curve. Finally, multivariate analysis was performed with V40 of the small bowel loops and 2 other clinical parameters that were judged to be potential risk factors for chronic GI complications: BMI and smoking. Of these 3 parameters, V40 of the small bowel loops and smoking emerged as independent predictors of chronic GI complications.


CONCLUSIONS
DVH parameters of the small bowel loops may serve as predictors of grade 2 or higher chronic GI complications after postoperative concurrent nedaplatin-based chemoradiation therapy for early-stage cervical cancer.
Department of Radiation Oncology, Osaka University Hospital, Suita, Osaka, Japan. isohashi@radonc.med.osaka-u.ac.jp
Fumiaki
F
Isohashi
Yasuo
Y
Yoshioka
Seiji
S
Mabuchi
Koji
K
Konishi
Masahiko
M
Koizumi
Yutaka
Y
Takahashi
Toshiyuki
T
Ogata
Shintaroh
S
Maruoka
Tadashi
T
Kimura
Kazuhiko
K
Ogawa
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007420:Intestine, Large / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000528:radiation effects; D007421:Intestine, Small / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000528:radiation effects*; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D058958:Organs at Risk / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000528:radiation effects*; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging / Q000528:radiation effects; D012372:ROC Curve; D011829:Radiation Dosage; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012907:Smoking / Q000009:adverse effects; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; C053989:nedaplatin