Effect of Hyaluronate Acid Injection on Dose-Volume Parameters in Brachytherapy for Cervical Cancer

Rei Kobayashi; Naoya Murakami; Takahito Chiba; Kae Okuma; Koji Inaba; Kana Takahashi; Tomoya Kaneda; Tairo Kashihara; Ayaka Takahashi; Yuri Shimizu; Yuko Nakayama; Tomoyasu Kato; Yoshinori Ito; Hiroshi Igaki

doi:10.1016/j.adro.2022.100918

Effect of Hyaluronate Acid Injection on Dose-Volume Parameters in Brachytherapy for Cervical Cancer

Adv Radiat Oncol. 2022 Feb 6;7(3):100918. doi: 10.1016/j.adro.2022.100918. eCollection 2022 May-Jun.

Authors

Affiliations

¹ Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
² Department of Radiation Oncology, Showa University Hospital, Tokyo, Japan.
³ Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan.
⁴ Department of Gynecologic Oncology, National Cancer Center Hospital, Tokyo, Japan.

Abstract

Purpose: Hyaluronate gel has been injected as a spacer into the rectovaginal fossa and vesicouterine fossa during brachytherapy for patients with cervical cancer at our institution. The effect of hyaluronate gel injection (HGI) on dose-volume parameters was investigated in this study.

Methods and materials: Between July 2008 to January 2020, a total of 104 patients (non-HGI group: 52 patients; HGI group: 52 patients) who underwent curative radiation therapy for cervical cancer were selected. The total doses of external beam radiation therapy and brachytherapy for high-risk clinical target volume (CTV_HR) D₉₀, bladder D_2cc, and rectal D_2cc were converted to the equivalent dose in 2 Gy fractions (EQD2) and were analyzed for association with HGI.

Results: Median CTV_HR D₉₀ (EQD2) in the non-HGI group was 76.0 Gy (63.7-99.5 Gy), and in the HGI group it was 79.4 Gy (52.6-97.5 Gy) (P = .017). The median bladder D_2cc and rectal D_2cc (EQD2) were 62.9 Gy and 56.0 Gy in the non-HGI group and 63.7 Gy and 54.8 Gy in the HGI group, which had no significant difference.

Conclusions: In cases with HGI, a significant CTV_HR D₉₀ dose increase was obtained with sufficient bladder and rectal doses suppression.