title: Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients.
abstract: Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancer patients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used.
  
  
  
  In a subset of patients from the EMBRACE study, vaginal doses were evaluated. Doses at the applicator surface left/right and anterior/posterior and at 5mm depth were measured. In addition, the dose at the Posterior-Inferior Border of Symphysis (PIBS) vaginal dose point and PIBS±2cm, corresponding to the mid and lower vagina, was measured.
  
  
  
  153 patients from seven institutions were included. Large dose variations expressed in EQD2 with α/β=3Gy were seen between patients, in particular at the top left and right vaginal wall (median 195 (range 61-947)Gy/178 (61-980)Gy, respectively). At 5mm depth, doses were 98 (55-212)Gy/91 (54-227)Gy left/right, and 71 (51-145)Gy/67 (49-189)Gy anterior/posterior, respectively. The dose at PIBS and PIBS±2cm was 41 (3-81)Gy, 54 (32-109)Gy and 5 (1-51)Gy, respectively. At PIBS+2cm (mid vagina) dose variation was coming from BT. The variation at PIBS-2cm (lower vagina) was mainly dependent on EBRT field border location.
  
  
  
  This novel method for reporting vaginal doses coming from EBRT and BT through well-defined dose points gives a robust representation of the dose along the vaginal axis. In addition, it allows comparison of vaginal dose between patients from different centres. The doses at the PIBS points represent the doses at the mid and lower parts of the vagina. Large variations in dose throughout the vagina were observed between patients and centres.
authors.affiliation: Department of Radiotherapy, Academic Medical Centre, University of Amsterdam, The Netherlands; Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria. Electronic address: g.h.westerveld@amc.uva.nl.
authors.forename: Henrike
authors.initials: H
authors.lastname: Westerveld
authors.affiliation: Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: de Leeuw
authors.affiliation: Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kirchheiner
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pittaya
authors.initials: P
authors.lastname: Dankulchai
authors.affiliation: Department of Radiation Oncology, Radiotherapiegroep, Arnhem, The Netherlands.
authors.forename: Bernard
authors.initials: B
authors.lastname: Oosterveld
authors.affiliation: Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Oinam
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Slovenia.
authors.forename: Robert
authors.initials: R
authors.lastname: Hudej
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Jamema
authors.initials: J
authors.lastname: Swamidas
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lindegaard
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Kari
authors.initials: K
authors.lastname: Tanderup
authors.affiliation: Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.affiliation: Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Kirisits
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D014621:Vagina / Q000528:radiation effects*
keywords: Brachytherapy; Cervical cancer; Dose points; Dose reporting; Radiotherapy; Vagina