Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2025
Dose-volume constraints for severe acute gastrointestinal toxicity in cervical cancer patients receiving extended-field intensity-modulated radiotherapy and concurrent chemotherapy.
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Gao Hui, Wu Haijing, Zhang Yue, Wang Shuai, Li Xiaokai, Qi Zhongchun, Wang Mingyi
Аннотация
BACKGROUND AND PURPOSE: Extended-field intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy may lead to severe toxicity. This study aims to investigate the incidence and dosimetric predictors of acute gastrointestinal toxicity in cervical cancer patients.
METHODS AND MATERIALS: Dosimetric data of the duodenum and small bowel loop from 273 eligible patients were analyzed. Logistic regression and Pearson's pairwise correlation were used to identify the best predictors. Receiver operating characteristic curves were used to determine the optimal cutoff values. Logistic models were established to predict the normal tissue complication probability.
RESULTS: Twenty-six patients experienced grades ≥ 3 (G3+) vomiting, while seven experienced G3+ diarrhea. Either the duodenal volume receiving ≥ 29 Gy (V29; p = 0.002) or V49 (p = 0.014) could predict the incidence of G3+ vomiting. The incidence was 1.3 % vs. 12.8 % in patients with V29 ≤ 43.5 % vs. > 43.5 % (p = 0.008). For patients with V49 ≤ 9.2 % vs. > 9.2 %, the incidence was 7.6 % vs. 16.1 % (p = 0.077). The plans for 22 patients had to be modified due to vomiting. It was found that duodenal V29 (p = 0.012) was a predictor for replanning, with an incidence of 3.3 % vs. 17.6 % in patients with V29 ≤ 51.3 % vs. > 51.3 % (p < 0.001). The V22 of the small bowel was selected to predict the incidence of G3+ diarrhea, which were 0.6 % and 5.6 % in patients with V22 ≤ 62.3 % and > 62.3 %, respectively (p = 0.031).
CONCLUSION: Limiting V29 and V49 of the duodenum, as well as V22 of the small bowel loop, may help reduce the risk of acute G3+ gastrointestinal toxicity when treating cervical cancer with extended-field concurrent IMRT.
METHODS AND MATERIALS: Dosimetric data of the duodenum and small bowel loop from 273 eligible patients were analyzed. Logistic regression and Pearson's pairwise correlation were used to identify the best predictors. Receiver operating characteristic curves were used to determine the optimal cutoff values. Logistic models were established to predict the normal tissue complication probability.
RESULTS: Twenty-six patients experienced grades ≥ 3 (G3+) vomiting, while seven experienced G3+ diarrhea. Either the duodenal volume receiving ≥ 29 Gy (V29; p = 0.002) or V49 (p = 0.014) could predict the incidence of G3+ vomiting. The incidence was 1.3 % vs. 12.8 % in patients with V29 ≤ 43.5 % vs. > 43.5 % (p = 0.008). For patients with V49 ≤ 9.2 % vs. > 9.2 %, the incidence was 7.6 % vs. 16.1 % (p = 0.077). The plans for 22 patients had to be modified due to vomiting. It was found that duodenal V29 (p = 0.012) was a predictor for replanning, with an incidence of 3.3 % vs. 17.6 % in patients with V29 ≤ 51.3 % vs. > 51.3 % (p < 0.001). The V22 of the small bowel was selected to predict the incidence of G3+ diarrhea, which were 0.6 % and 5.6 % in patients with V22 ≤ 62.3 % and > 62.3 %, respectively (p = 0.031).
CONCLUSION: Limiting V29 and V49 of the duodenum, as well as V22 of the small bowel loop, may help reduce the risk of acute G3+ gastrointestinal toxicity when treating cervical cancer with extended-field concurrent IMRT.