title: Tolerance of the vaginal vault to high-dose rate brachytherapy and concomitant chemo-pelvic irradiation: Long-term perspective.
abstract: OBJECTIVE
  We sought to determine the tolerance level and complication rates of the vaginal vault to combined high-dose-rate intra-cavitary brachytherapy with concomitant chemo-radiotherapy.
  
  
  METHODS
  A retrospective review of medical records of all the patients who received definitive chemo-radiotherapy for cervical cancer between 1998 and 2002 was undertaken. The records were reviewed for doses and for radiation-associated early and late sequelae of the vagina, rectum and bladder. Cumulative biological effective dose was calculated for two reference vaginal surface points.
  
  
  RESULTS
  Fifty patients were included. Average age at diagnosis was 54 years. Median follow-up was 59 months. There were no recorded instances of acute grade IV toxicity. Maximal high-dose-rate vaginal surface dose (upper central point) was 103 Gy, and maximal brachytherapy lateral surface dose was 70 Gy. Maximal cumulative biological effective dose for the lateral surface reference point was 465.5 Gy3, and the maximal cumulative biological effective dose for the superior reference point was 878.6 Gy3. There were no cases of vaginal necrosis or fistulas, and no cases of grade IV late vaginal, rectal or bladder toxicity. No correlation was found between the maximal vaginal surface dose and vaginal, rectal or bladder toxicity.
  
  
  CONCLUSIONS
  The maximal surface HDR brachytherapy dose of 103 Gy and the maximal cBED of 878.6 Gy3 were not associated with fistula or necrosis or other grade 3-4 vaginal complications. Concomitant chemo-radiotherapy, including pelvic radiotherapy and high-dose-rate intracavitary brachytherapy, is relatively safe for cervical cancer patients.
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Kaidar-Person
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Roxolyana
authors.initials: R
authors.lastname: Abdah-Bortnyak
authors.affiliation: Gyneco-Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Amnon
authors.initials: A
authors.lastname: Amit
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nevelsky
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Alison
authors.initials: A
authors.lastname: Berniger
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Raquel
authors.initials: R
authors.lastname: Bar-Deroma
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Rahamim
authors.initials: R
authors.lastname: Ben-Yosef
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Kuten
keywords: Brachytherapy; High-dose-rate; Irradiation; Tolerance; Vagina