Physician assessed and patient reported urinary morbidity after radio-chemotherapy and image guided adaptive brachytherapy for locally advanced cervical cancer

Lars Fokdal, Richard Pötter, Kathrin Kirchheiner, Jacob Chr Lindegaard, Nina Boje Kibsgaard Jensen, Christian Kirisits, Cyrus Chargari, Umesh Mahantshetty, Ina Maria Jürgenliemk-Schulz, Barbara Segedin, Peter Hoskin, Kari Tanderup

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND PURPOSE: The EMBRACE study is a prospective multi-institutional study on MRI guided adaptive brachytherapy (IGABT) in locally advanced cervix cancer (LACC). This analysis describes early to late urinary morbidity assessed by physicians and patients (PRO).

MATERIAL AND METHODS: A total of 1176 patients were analysed. Median follow up (FU) was 27 (1-83) months. Morbidity (CTCAE v.3) and PRO (EORTC QLQ-C30&CX24) was prospectively assessed at baseline (BL), and during FU.

RESULTS: The most frequent symptoms were frequency/urgency, incontinence, and cystitis with grade 2-4 prevalence rates of 4.3%, 5.0% and 1.7% and grade 1-4 prevalence rates of 24.5%, 16.1% and 5.8% at 3-years. The most frequent PRO endpoints were "urinary frequency" and "leaking of urine". Prevalence of "Quite a bit" or "very much" bother fluctuated from 14.0% to 21.5% for "frequency", while "leaking of urine" increased from 4.6% at BL to 9.3% at 3-years. Actuarial 3-year incidence of grade 3-4 urinary morbidity was 5.3% with most events being urinary frequency, incontinence and ureteral strictures. Grade 3-4 fistula, bleeding, spasm and cystitis were all <1.0% at 3/5-years. No grade 5 toxicity occurred.

CONCLUSION: Urinary grade 3-4 morbidity with IGABT was limited. Urinary morbidity grade 2-4 comprises mainly frequency/urgency, incontinence and cystitis and has considerable prevalence in PRO. Various urinary morbidity endpoints have different patterns of manifestation and time course.

Original languageEnglish
Pages (from-to)423-430
Number of pages8
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Issue number3
Early online date18 May 2018
Publication statusPublished - Jun 2018


  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy/adverse effects
  • Chemoradiotherapy/adverse effects
  • Cisplatin/administration & dosage
  • Female
  • Humans
  • Lower Urinary Tract Symptoms/chemically induced
  • Magnetic Resonance Imaging/methods
  • Middle Aged
  • Morbidity
  • Patient Reported Outcome Measures
  • Prospective Studies
  • Radiation Injuries/chemically induced
  • Radiotherapy, Image-Guided/adverse effects
  • Urinary Bladder/drug effects
  • Urinary Tract/drug effects
  • Uterine Cervical Neoplasms/diagnostic imaging
  • Young Adult

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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