Body Mass Index and Doses at Organs at Risk in a Mediterranean Population Treated with Postoperative Vaginal Cuff Brachytherapy

Abstract

Purpose: Association between body mass index (BMI) and doses in organs at risk during postoperative vaginal cuff brachytherapy (VCB) treatment has not been evaluated. The aim of this study was to analyse the impact of BMI on the dose delivered to bladder and rectum during high-dose-rate VCB using computed tomography (CT) scans at every fraction. Materials and Methods: A retrospective analysis of 220 planning CT sets derived from 59 patients was conducted. Every planning CT was re-segmented and re-planned under the same parameters. Rectum and bladder dose-volume histogram values (D-0.1cc, D-1cc, and D-2cc) were extracted and evaluated. The mean values for all applications per patient were calculated and correlated with BMI, as well as other factors influencing rectal and bladder doses. Multiple regression analysis performed to model organ at risk dose-volume parameters. Results: According to World Health Organization (WHO), 6.8% of patients were normal, 35.6% were overweight, and 57.6% were class I obese. Median rectal doses were 133.5%, 110.9%, and 99.3% for D-0.1cc, D-1cc, and D-2cc, respectively. The corresponding median bladder doses were 96.2%, 80.6%, and 73.3%, respectively. BMI did not show significant association with rectal doses. However, BMI did show a significant association with evaluated bladder dose metrics (D-0.1cc, r=-0.366, p=0.004; D-1cc, r=-0.454, p < 0.001; D-2cc, r=-0.451, p < 0.001). BMI was retained in the multivariate regression models (D-0.1cc, p=0.004; D-1cc, p < 0.001; D-2cc, p=0.001). Conclusion: In this group of Mediterranean, overweight, and moderately obese patients, BMI showed association with lower bladder dose values, but not with rectal doses.