title: Dose-volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy.
abstract: The purpose of this study is to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in patients with cervical cancer who have undergone postoperative concurrent chemotherapy and whole-pelvic radiation therapy (WPRT). The subjects were 135 patients who had undergone postoperative WPRT with concurrent nedaplatin-based chemotherapy between 2000 and 2014. Associations between selected DVH parameters and the incidence of chronic GI complications of G3 or higher were evaluated. Chronic GI complications of severity G3 occurred in 18 (13%) patients. Patients with GI complications had significantly greater V5-V45, mean dose and the generalized equivalent uniform dose (gEUD) of the small bowel loops, compared with those without GI complications. V30-V45, mean dose and gEUD of the bowel bag also showed significant differences between patients with and without GI complications. In contrast, no parameter for the large bowel loop was correlated with GI complications. Receiver operating characteristics curve analysis indicated that V30-V45 of the small bowel loops were better predictors than these respective parameters for the bowel bag. Next, patients were divided into four groups based on the median V15 and V40 of the small bowel loops. The group with both a high V15 and a high V40 showed a significantly higher probability of chronic GI complications. In conclusion, the small bowel loops are better predictors of chronic GI complications compared with the bowel bag, and a relatively high-dose volume (e.g. V40) of the small bowel loops is a useful predictor of chronic GI complications.
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan isohashi@radonc.med.osaka-u.ac.jp.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Isohashi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Mabuchi
authors.affiliation: Department of Radiology, Suita Tokushukai Hospital.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Akino
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yoshioka
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Seo
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Suzuki
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tamari
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kobayashi
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Iori
authors.initials: I
authors.lastname: Sumida
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Mizuno
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Okubo
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D001918:Brachytherapy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D004358:Drug Therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011184:Postoperative Period; D012372:ROC Curve; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery
keywords: cervical cancer; chronic complication; dose–volume histogram; gastrointestinal; postoperative; radiotherapy