title: Re-irradiation using interstitial brachytherapy increases vaginal mucosal reaction compared to initial brachytherapy in patients with gynecological cancer.
abstract: OBJECTIVE
  To examine the vaginal mucosal reaction in gynecological cancer patients after re-irradiation using interstitial brachytherapy (re-ISBT) compared to initial brachytherapy.
  
  
  METHODS
  A comparison was made between re-ISBT (n=14) and the initial brachytherapy group consisting of 63 cases of intracavitary brachytherapy (ICBT) and 37 of interstitial brachytherapy (ISBT). We examined the modified Dishe score at 6, 12, 18, 24, 36, and 60 months after treatment with a median follow-up time of 41 months (range: 6-144 months). Re-ISBT was performed using 42-51 Gy in 7-8 fractions in 2-5 days (twice a day) without external irradiation.
  
  
  RESULTS
  For bleeding and discharge, fewer than 10% of patients exhibited grade 1 reactions and no statistically significantly differences were found between re-ISBT and initial brachytherapy. Re-ISBT increased erythema (grade 0/1/2=29%/57%/14%) compared with initial brachytherapy (grade 0/1/2=64%/31%/5%, p=0.03). Four out of 14 patients had grade 1 ulceration or higher after re-ISBT, whereas five patients experienced grade 1 ulceration after initial in brachytherapy (p=0.001). Notably, a fistula appeared in one patient in the re-ISBT group. There is no difference between re-ISBT and fresh brachytherapy with regard to telangiectasia, stenosis and pallor reactions. Increased cumulative (previous plus present treatment) equivalent dose in a 2-Gy fraction was correlated to a higher grade of erythema and ulceration.
  
  
  CONCLUSIONS
  Re-ISBT increased the vaginal mucosal reaction, as shown by increased erythema and ulceration, more than initial brachytherapy, with a higher cumulative radiation dose, but the reaction was mild in almost all cases.
authors: Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan. hideya10@hotmail.com.
authors: Ken
authors: K
authors: Yoshida
authors: Hideya
authors: H
authors: Yamazaki
authors: Satoaki
authors: S
authors: Nakamura
authors: Koji
authors: K
authors: Masui
authors: Tadayuki
authors: T
authors: Kotsuma
authors: Hironori
authors: H
authors: Akiyama
authors: Eiichi
authors: E
authors: Tanaka
authors: Yasuo
authors: Y
authors: Yoshioka
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000528:radiation effects; D014621:Vagina / Q000528:radiation effects*
keywords: Brachytherapy; gynecological cancer; high dose rate; interstitial brachytherapy; late vaginal mucosal reaction; re-irradiation