Association of bladder dose with late urinary side effects in cervical cancer high-dose-rate brachytherapy

Publication date: Available online 17 August 2017
Source:Brachytherapy
Author(s): Roja Zakariaee, Ghassan Hamarneh, Colin J. Brown, Marc Gaudet, Christina Aquino-Parsons, Ingrid Spadinger
PurposeThe purpose of this work was to study the association between specific urinary sequelae and locally accumulated dose to the bladder wall and bladder neck in the treatment of cervical cancer with multifraction high-dose-rate (HDR) brachytherapy.Methods and MaterialsA cohort of 60 cervical cancer patients, treated with both external beam and five HDR brachytherapy insertions between 2008 and 2014 at the BC Cancer Agency, was identified. The accumulated dose received over five brachytherapy sessions was evaluated for the bladder wall and bladder neck of each patient using dosimetric parameters calculated from deformably registered image data sets. These parameters were examined as potential predictors of urinary sequelae including hematuria, frequency, urgency, incontinence, stream, nocturia, and dysuria. Two different dichotomization schemes were evaluated for grouping patients into Case and Control groups. The two-sample Student's t test was used for normally distributed samples and the Mann–Whitney nonparametric U test for non-normal distributions.ResultsA strong association between dose to the bladder neck and incontinence was found (p = 0.001). A statistically significant association (p < 0.05) was also observed between urgency and certain bladder-wall parameters.ConclusionsLocalized dose to the bladder neck is a potential predictor of urinary incontinence, whereas weaker associations were observed between urgency and some bladder-wall parameters.



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