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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.

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Department of Oncology, Aarhus University Hospital, Denmark. Electronic address:
Department of Oncology, Aarhus University Hospital, Denmark.
Department of Radiation Oncology, Medical University of Vienna, Austria.
Department of Radiotherapy, Gustave-Roussy, France.
Department of Radiation Oncology, Utrecht University, Netherlands.
Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia.
Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke's Hospital, Cambridge University Hospitals, United Kingdom.
Mount Vernon Cancer Centre, Northwood, United Kingdom.
Tata Memorial Hospital, India.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Department of Radiation Oncology, Regional Cancer Centre, Chandigarh, India.



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.


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.


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.


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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