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Int J Radiat Oncol Biol Phys. 2018 Nov 9. pii: S0360-3016(18)33953-1. doi: 10.1016/j.ijrobp.2018.11.006. [Epub ahead of print]

Risk factors for ureteral stricture following radiochemotherapy including image guided adaptive brachytherapy in cervical cancer: results from the XXXXXXX studies.

Author information

1
Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: Larfok@rm.dk.
2
Department of Oncology, Aarhus University Hospital, Denmark.
3
Department of Radiation Oncology, Medical University of Vienna, Austria.
4
Department of Radiotherapy, Gustave-Roussy, France.
5
Department of Radiation Oncology, Utrecht University, Netherlands.
6
Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia.
7
Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke's Hospital, Cambridge University Hospitals, United Kingdom.
8
Mount Vernon Cancer Centre, Northwood, United Kingdom.
9
Tata Memorial Hospital, India.
10
Department of Oncology, Oslo University Hospital, Oslo, Norway.
11
Department of Radiation Oncology, Regional Cancer Centre, Chandigarh, India.

Abstract

BACKGROUND:

and purpose: Ureteral stricture is a rare but severe side effect, after radiotherapy for locally advanced cervical cancer (LACC). This report describes the incidence and predictive factors for ureteral stricture in a large patient cohort treated with 3D image guided adaptive brachytherapy (IGABT) and radiochemotherapy within the XXXXXXX studies.

MATERIAL AND METHODS:

A total of 1860 patients were included. Treatment consisted of external beam radiotherapy (45-50 Gy in 25-30 fx), concomitant Cisplatin and IGABT. Grade 3-4 ureteral strictures were assessed with CTCAE v. 3.0. Predictive factors for grade 3-4 ureteral stricture were analysed. These factors included: age, hydronephrosis on imaging at time of diagnosis, TNM stage, CTVHR volume, laparoscopic staging, chemotherapy, radiotherapy doses to targets and organs at risk, applicator type, intracavitary (IC) versus intracavitary/interstitial (IC/IS) technique, and dose-rate.

RESULTS:

At a median follow up of 34 (2-163) months, 31 patients were diagnosed with grade 3-4 ureteral stricture. Actuarial 3 and 5-year risk for ureteral stricture grade 3-4 was 1.7% and 2.1% for all patients. Advanced tumor stage T3-4 with hydronephrosis at diagnosis was the only independent risk factors for ureteral stricture (p=0.01). Patients with TNM stage T1 (n=359) and T2 (n=1085) had a low risk of 0.4%/1.0% and 1.0%/1.0% at 3/5 years, respectively. Patients (n=274) with T3-T4 without hydronephrosis at diagnosis had a 3/5 year risk of 2.2%/4.8%, compared to 11.5%/11.5% in T3-T4 patients (n=142) with baseline hydronephrosis.

CONCLUSION:

Severe to life threatening ureteral stricture occurs rarely in LACC patients with T1-2 tumors. The risk for ureteral stricture is significantly increased in patients with T3-T4 tumors with hydronephrosis at diagnosis.

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