title: Late toxicity of brachytherapy after female genital tract tumors treated during childhood: Prospective evaluation with a long-term follow-up.
abstract: OBJECTIVE
  To prospectively assess the long-term toxicities of brachytherapy in female survivors with localized genital tract tumors.
  
  
  METHODS
  The data concerning 42 patients treated at Gustave Roussy between 1971 and 2004, were both retrospectively and prospectively analyzed. Strictly confidential constructed surveys based on the LENT SOMA/SF-36v2 questionnaires were mailed and 51% were completed. Complications were recorded throughout the follow-up period and graded according to CTCAE, version 4.0.
  
  
  RESULTS
  The median age at diagnosis was 1.7 years (range, 0.6-16.6) and most patients (69%) had rhabdomyosarcomas. Treatments included brachytherapy delivered in all patients, chemotherapy (88%), surgery (31%), and external beam radiotherapy (5%). At a median follow-up of 15.5 years, 41/42 patients were alive. A total of 160 late effects were identified in 32/42 (76%) patients: 72% G1-2, and 28% G3-4 (the mean number of all grade late effects per patient: 4 [median: 2.5; range, 0-16] and the mean number of G3-4 late effects per patient: 1[median: 0; range, 0-8]). The most common all grade late toxicities were gynecological (75/160; 47%) and G3-4 were urinary (24/45; 53%). Sixteen patients (38%) required surgical treatment of late complications. The 15-year actuarial incidence rate of G3-4 late effects was 51%. The total number of all grade and G3-4 late effects was significantly increased in patients treated before 1990 (p=0.005 and p=0.008), when the cumulative dose was higher (p=0.03 and p=0.02), when the maximal dose was delivered to the ovaries (p=0.002 and p=0.04), and when the brachytherapy volume was larger (p=0.03 and p=0.02). Quality of life was good or very good in 91% of patients who completed the surveys.
  
  
  CONCLUSIONS
  Long-term effects decreased with advances in treatment. Stringently controlled brachytherapy parameters should allow us to pursue improvements in order to prevent or minimize long-term sequelae.
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, France; Paris Sud University, France.
authors.forename: Antonin
authors.initials: A
authors.lastname: Levy
authors.affiliation: Department of Pediatric Surgery, Bicêtre Hospital, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Martelli
authors.affiliation: Department of Pediatrics, Gustave Roussy, France.
authors.forename: Chiraz
authors.initials: C
authors.lastname: Fayech
authors.affiliation: Department of Pediatrics, Gustave Roussy, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Minard-Colin
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, France.
authors.forename: Marie-Catherine
authors.initials: MC
authors.lastname: Gensse
authors.affiliation: Department of Biostatistics, Gustave Roussy, France.
authors.forename: Marie-Cecile
authors.initials: MC
authors.lastname: Le Deley
authors.affiliation: Department of Pediatrics, Gustave Roussy, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Oberlin
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, France. Electronic address: christine.haiemeder@gustaveroussy.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
mesh_terms: D000293:Adolescent; D001918:Brachytherapy / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D058958:Organs at Risk / Q000528:radiation effects; D011446:Prospective Studies; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors
keywords: Brachytherapy; Childhood cancer; Genital tract cancer; Gynecology; Long-term toxicity; Quality of life