Vaginal Cuff Treatment and Subsequent Quality of Life Related Recommendations in Radiation Oncology Practice: Turkish Oncology Group Study Survey Report

The American Brachytherapy Association is attempting to develop standards but the differences in practice are also emphasized in the literature. The aim of this study was to evaluate the approach to vaginal cuff treatment practice and subsequent quality of life related recommendations of Turkish Radiation Oncologists. A nationwide web-based survey with 16 focused items, was distributed to the members of Turkish Society for Radiation Oncology (TSRO) through email notification & posted link on TSRO website to respond on a volunteer basis from January 2nd to February 12th, 2018. The time required to complete the survey was approximately 4 minutes. A total of 54 Radiation Oncologists answered the survey. The most commonly used dose fraction schemes were 7 Gy x 3 fractions (29,6%), 5.5 Gy x 5 fractions (27.7%) and 6 Gy x 5 fractions (25.9%) for adjuvant vaginal cuff brachytherapy. The preferred schema for vaginal cuff brachytherapy in combination with external radiotherapy (45 Gy), were 5 Gy x 3 fractions (50.9%) and 6 Gy x 3 fractions (33.9%). The application dose was frequently modified as 6 Gy x 3 fractions (28.3%) or 5 Gy x 3 fractions (33,9%) when the external radiotherapy dose was increased to 50.4 Gy. Half of the participants, applied brachytherapy as 2 fractions per week and the common approach was prescribing the dose to 0.5 cm from the mucosa (86.7%). Foley catheter was usually applied for every fraction by 46.3% while 35.1% did not suggest its use. Bowel preparation was recommended for every application by 51.8 % of the participating radiation oncologists. CT-based planning for the first fraction was performed by 68.5% while 12.9% did not use CT-based planning. There was no common definition for dose prescription length; 33% of the survey responders preferred defining it as the first 3 cm, 37% as the first 4 cm, 11% as the whole cylinder and the rest as a third of the vaginal length. The dose prescription for the serous and clear cell histological types, 40% of the participants advised "full cylinder length" as target and the dose preference was similar to the conventional dose schemas for adenocancer. The percentage of those who recommended a dilator or intercourse after treatment was 79.2%. The survey results revealed that approaches to the clinical practice of vaginal cuff brachytherapy varies although it deemed to be a simple intervention.