ArticleRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology2016
Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study.
Article in Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 70 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pelvic Physiotherapy in the Prevention of Vaginal Stenosis Secondary to Radiotherapy of Gynecological Cancer: a Randomized Controlled Trial
Evaluation of Vaginal Dose in Cervical Cancer Patients Treated With Radiotherapy
An Enhanced Vaginal Dilator Model to Improve Patient Adherence and Reduce Radiation-Induced Vaginal Stenosis: a Randomized Control Trial
Vaginal Dilatators and Moisturizers Use and Sexual Quality of Life of Patients With Gynecologic Cancer Treated With Brachytherapy.
Who cites it
70 citing papers in PubMed, 4 syntheses or guidelines pooled it, 208 citations in OpenAlex.
- Let's talk about sex: consensus guidelines of the GINECOR working group of the Spanish Society of Radiation Oncology: clinical recommendations after pelvic radiotherapy.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025Guideline
- Prevention and management of radiotherapy-related toxicities in gynecological malignancies. Position paper on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology).La Radiologia medica · 2024Guideline
- Dose-response relationship between volume base dose and tumor local control in definitive radiotherapy for vaginal cancer.BMC cancer · 2024Pooled it
- Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.Practical radiation oncologyGuideline
- Efficacy of a nurse-led sexual rehabilitation intervention for women with gynaecological cancers receiving radiotherapy: results of a randomised trial.British journal of cancer · 2024Trial
- Phase I/II prospective clinical trial for the hybrid of intracavitary and interstitial brachytherapy for locally advanced uterine cervical cancer.Journal of gynecologic oncology · 2023Trial
- Vaginal dose of radical radiotherapy for cervical cancer in China: a multicenter study.BMC cancer · 2019Trial
- Clinical and Psychological Outcomes of the Use of Vaginal Dilators After Gynaecological Brachytherapy: a Randomized Clinical Trial.Advances in therapy · 2019Trial
- Effects of rectal retractor use on dosimetric parameters, treatment-related adverse events, and clinical outcomes of cervical cancer brachytherapy: A retrospective tertiary-centre study.Clinical and translational radiation oncology · 2027Article
- Vaginal dilator therapy for pelvic cancer patients: a review.Gynecologic oncology reports · 2026Review
- Sexual function in chronic illness and cancer perspectives of the patient, partner, and healthcare provider; innovations; and updates: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).Sexual medicine reviews · 2026Review
- Rectovaginal fistulas after radiation therapy: treatment options and outcomes - a narrative review.Frontiers in oncology · 2026Review
- Personalized brachytherapy in gynecological cancers: procedural narrative in patients with a poor response or challenging anatomy after chemoradiation.Journal of contemporary brachytherapy · 2025Article
- Review
- HPV-driven cancer: from epidemiology to the HPV-driven tumor board proposal, everything you wanted to know but were afraid to ask.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025Review
- Advancing the evaluation of radiation-induced vaginal toxicity using ultrasound radiomics: Phantom validation and pilot clinical study.Medical physics · 2025Article
- Epidemiology, etiology and treatment of female vaginal injury.Reproductive health · 2025Review
- Radiotherapy for recurrent venous malformation involving the thigh and pelvic organs while preserving organ function: a case report.Frontiers in cardiovascular medicine · 2025Article
- Study on the relationship between vaginal dose and radiation-induced vaginal injury following cervical cancer radiotherapy, and model development.Frontiers in public health · 2025Article
- Impact of Vaginal Dilator Use and 68 Gy EQD2Journal of personalized medicine · 2024Article
10 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors at 11 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background/purposeTo identify risk factors for vaginal stenosis and to establish a dose-effect relationship for image-guided brachytherapy in locally advanced cervical cancer. MATERIALS/
methodsPatients from the ongoing EMBRACE study with prospectively assessed morbidity (CTCAEv3.0) at baseline and at least one follow-up were selected. Patient-, disease- and treatment characteristics were tested as risk factors for vaginal stenosis G ⩾ 2 in univariate and multivariable analyses (Cox proportional hazards model) and a dose-effect curve was deduced from the estimates. The ICRU rectum point was used to derive the recto-vaginal reference point dose.
resultsIn 630 patients included (median follow-up 24months), 2-year actuarial estimate for vaginal stenosis G ⩾ 2 was 21%. Recto-vaginal reference point dose (HR=1.025, p=0.029), external beam radiotherapy (EBRT) dose >45 Gy/25 fractions (HR=1.770, p=0.056) and tumor extension in the vagina (HR=2.259, p ⩽ 0.001) were risk factors for vaginal stenosis, adjusted for center reporting effects. Based on the model curve, the risk was 20% at 65 Gy, 27% at 75 Gy and 34% at 85 Gy (recto-vaginal reference point dose).
conclusionKeeping the EBRT dose at 45 Gy/25 fractions and decreasing the dose contribution of brachytherapy to the vagina decrease the risk of stenosis. A planning aim of ⩽65 Gy EQD2 (EBRT+brachytherapy dose) to the recto-vaginal reference point is therefore proposed.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.