TY  - JOUR
A1  - Murakami, Naoya
A1  - Shima, Satoshi
A1  - Kashihara, Tairo
A1  - Tselis, Nikolaos
A1  - Kato, Tomoyasu
A1  - Takagawa, Yoshiaki
A1  - Masui, Koji
A1  - Yoshida, Ken
A1  - Takahashi, Kana
A1  - Inaba, Koji
A1  - Okuma, Kae
A1  - Igaki, Hiroshi
A1  - Nakayama, Yuko
A1  - Itami, Jun
T1  - Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer : an effective approach for bladder dose reduction
T2  - Journal of contemporary brachytherapy
N2  - Purpose: The purpose of this study was to report our initial experience of hyaluronic acid gel injection (HGI) in the vesicovaginal septum (VVS) for bladder dose reduction in brachytherapy (BT) for uterine cervical carcinoma.
Material and methods: Between September 2016 and May 2018, 15 uterine cervical cancer patients received HGI in the VVS as a part of their definitive radiotherapy (RT) treatment consisting of external beam radiation therapy (EBRT) with additional BT. Of those, 9 patients received BT both with and without HGI, and remaining 6 patients were excluded because these 6 patients received HGI in the VVS for all BT fractions. All 9 patients received HGI in the rectovaginal septum. For these patients, the dosimetric parameters bladder D2cc, HR-CTV D90, and rectum D2cc were selected, and two groups were generated (BT with vs. without HGI in the VVS) for dosimetric comparison.
Results: The median cumulative EQD2 for HR-CTV, rectum D2cc, and bladder D2cc for the 9 patients were 73.3, 52.8, and 67.1, respectively. While no statistical difference could be detected for rectal dose reduction, bladder dose was significantly less in the group with HGI in the VVS compared to that without (449 cGy [range, 416-566, 1SD = 66.1] vs. 569 cGy [range, 449-647, 1SD = 59.5], p = 0.033), with no compromising of target coverage. Although it did not reach statistically significance, there was a trend toward better HR-CTV D90 in the group with HGI compared to that without HGI in the VVS (713 cGy vs. 706 cGy, p = 0.085). No severe bleeding, hematuria, bladder wall injury, or urethral injury requiring hospitalization was experienced in association with HGI in the VVS.
Conclusions: HGI in the VVS can be performed safely and can effectively reduce the bladder dose in BT for uterine cervical cancer patients.
KW  - uterine cervical cancer
KW  - brachytherapy
KW  - gel spacer injection
KW  - bladder dose
KW  - vesicovaginal septum
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50365
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-503651
SN  - 1689-832X
SN  - 2081-2841
N1  - Copyright: © 2019 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
VL  - 11
IS  - 1
SP  - 1
EP  - 7
PB  - Termedia
CY  - Poznań
ER  -