{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:04:58Z","timestamp":1740146698558,"version":"3.37.3"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T00:00:00Z","timestamp":1618531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"crossref","award":["CAN 2006\/1321"],"award-info":[{"award-number":["CAN 2006\/1321"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","award":["CAN 2009\/1099"],"award-info":[{"award-number":["CAN 2009\/1099"]}],"id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Cancerfonden, Jubileums Kliniken","award":["2018-194"],"award-info":[{"award-number":["2018-194"]}]},{"name":"ALF agreement","award":["ALFGBG-943266"],"award-info":[{"award-number":["ALFGBG-943266"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The study aims to determine possible dose-volume response relationships between the rectum, sigmoid colon and small intestine and the \u2018excessive mucus discharge\u2019 syndrome after pelvic radiotherapy for gynaecological cancer.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and materials<\/jats:title>\n<jats:p>From a larger cohort, 98 gynaecological cancer survivors were included in this study. These survivors, who were followed for 2 to 14 years, received external beam radiation therapy but not brachytherapy and not did not have stoma. Thirteen of the 98 developed excessive mucus discharge syndrome. Three self-assessed symptoms were weighted together to produce a score interpreted as \u2018excessive mucus discharge\u2019 syndrome based on the factor loadings from factor analysis. The dose-volume histograms (DVHs) for rectum, sigmoid colon, small intestine for each survivor were exported from the treatment planning systems. The dose-volume response relationships for excessive mucus discharge and each organ at risk were estimated by fitting the data to the Probit, RS, LKB and gEUD models.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The small intestine was found to have steep dose-response curves, having estimated dose-response parameters: <jats:italic>\u03b3<\/jats:italic><jats:sub><jats:italic>50<\/jats:italic><\/jats:sub>: 1.28, 1.23, 1.32, <jats:italic>D<\/jats:italic><jats:sub><jats:italic>50<\/jats:italic><\/jats:sub>: 61.6, 63.1, 60.2 for Probit, RS and LKB respectively. The sigmoid colon (AUC: 0.68) and the small intestine (AUC: 0.65) had the highest AUC values. For the small intestine, the DVHs for survivors with and without excessive mucus discharge were well separated for low to intermediate doses; this was not true for the sigmoid colon. Based on all results, we interpret the results for the small intestine to reflect a relevant link.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>An association was found between the mean dose to the small intestine and the occurrence of \u2018excessive mucus discharge\u2019. When trying to reduce and even eliminate the incidence of \u2018excessive mucus discharge\u2019, it would be useful and important to separately delineate the small intestine and implement the dose-response estimations reported in the study.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250004","type":"journal-article","created":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T18:19:15Z","timestamp":1618597155000},"page":"e0250004","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dose-response relationships of intestinal organs and excessive mucus discharge after gynaecological radiotherapy"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3432-4866","authenticated-orcid":true,"given":"Eleftheria","family":"Alevronta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor","family":"Skokic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail","family":"Dunberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Bull","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Bergmark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecka","family":"J\u00f6rnsten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunnar","family":"Steineck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,16]]},"reference":[{"issue":"6","key":"pone.0250004.ref001","doi-asserted-by":"crossref","DOI":"10.1038\/bjc.2011.315","article-title":"Late symptoms in long-term gynaecological cancer survivors after radiation therapy: A population-based cohort study","volume":"105","author":"H Lind","year":"2011","journal-title":"Br J Cancer"},{"key":"pone.0250004.ref002","article-title":"The gastrointestinal mucus system in health and disease","author":"MEV Johansson","year":"2013","journal-title":"Nature Reviews Gastroenterology and Hepatology"},{"key":"pone.0250004.ref003","article-title":"Immunological aspects of intestinal mucus and mucins","author":"MEV Johansson","year":"2016","journal-title":"Nature Reviews Immunology"},{"key":"pone.0250004.ref004","article-title":"Self-reported symptoms of faecal incontinence among long-term gynaecological cancer survivors and population-based controls","author":"G Dunberger","year":"2010","journal-title":"Eur J Cancer"},{"issue":"6","key":"pone.0250004.ref005","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1038\/bjc.2011.315","article-title":"Late symptoms in long-term gynaecological cancer survivors after radiation therapy: a population-based cohort study","volume":"105","author":"H Lind","year":"2011","journal-title":"Br J Cancer"},{"issue":"2","key":"pone.0250004.ref006","doi-asserted-by":"crossref","first-page":"e0171461","DOI":"10.1371\/journal.pone.0171461","article-title":"Identifying radiation-induced survivorship syndromes affecting bowel health in a cohort of gynecological cancer survivors","volume":"12","author":"G Steineck","year":"2017","journal-title":"PLoS One"},{"issue":"4","key":"pone.0250004.ref007","first-page":"509","article-title":"Remarks on Parallel Analysis. 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