{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:12:37Z","timestamp":1784632357200,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: To evaluate clinical and dosimetric predictors of vaginal toxicity in patients treated with vaginal-cuff brachytherapy (VCB), with or without external beam radiotherapy (EBRT), and assess the impact of different prescription and optimization strategies on dose\u2013volume parameters. Methods: We retrospectively analyzed 217 patients treated with EBRT combined with VCB (n = 120) or VCB alone (n = 97). In VCB three prescription and optimization strategies (volume-based, graphical optimization, and 5 mm distance-based prescription) were compared to determine differences in dose\u2013volume parameters. In patients who developed late vaginal side effects, the dosimetric parameters were evaluated using descriptive statistics and Cox regression modeling. Kaplan\u2013Meier analysis was performed to assess time to toxicity. Results: In the EBRT+VCB cohort, 34\/120 patients (28.3%) developed grade 1\u20132 vaginal toxicity compared to 35\/97 (36%) in the VCB alone cohort. In the EBRT+VCB group, patients with toxicity received a higher D90 per fraction and higher vaginal D2cc. In multivariable analysis, vaginal D2cc (HR = 1.60, 95% CI = 1.01\u20132.54, p = 0.045) and CTV-DVH (HR = 0.77, 95% CI = 0.61\u20130.97, p = 0.027) were independently associated with toxicity. No significant dose\u2013toxicity associations were observed in the VCB-alone cohort. Most events occurred within 48 months in both groups. Comparison of prescription strategies showed systematic differences in target and organ-at-risk dose\u2013volume parameters, including vaginal D2cc. The 5 mm distance-based prescription consistently resulted in higher D90, D100, EQD2, and vaginal D2cc values. Conclusions: In patients receiving EBRT combined with VCB, both vaginal D2cc and target dose distribution were associated with vaginal toxicity. The prescription and optimization strategy significantly influenced dose\u2013volume parameters. Planning methodology and dosimetric aspects should be considered when interpreting dose\u2013toxicity relationships in vaginal brachytherapy.<\/jats:p>","DOI":"10.3390\/cancers18142350","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:35:52Z","timestamp":1784630152000},"page":"2350","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["D90 and D2CC Dose in Vaginal CTV as Dosimetric Predictors of Late Vaginal Side Effects in Postoperative Vaginal Modern Brachytherapy (Interventional Radiotherapy) After External Beam Irradiation in Endometrial Cancer"],"prefix":"10.3390","volume":"18","author":[{"given":"Yao","family":"Qiang","sequence":"first","affiliation":[{"name":"Fonaments Cl\u00ednics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Radiation Oncology Department, Hospital Cl\u00ednic Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7970-876X","authenticated-orcid":false,"given":"Faegheh","family":"Noorian","sequence":"additional","affiliation":[{"name":"Fonaments Cl\u00ednics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4487-4431","authenticated-orcid":false,"given":"Rosa","family":"Abellana","sequence":"additional","affiliation":[{"name":"Fonaments Cl\u00ednics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), C\/Casanovas 153, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Baltrons","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, Hospital Cl\u00ednic Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3507-7051","authenticated-orcid":false,"given":"Valentina","family":"Lancellotta","sequence":"additional","affiliation":[{"name":"Dipartimento di Diagnostica per Immagini, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica ed Ematologia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Tagliaferri","sequence":"additional","affiliation":[{"name":"Dipartimento di Diagnostica per Immagini, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica ed Ematologia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaume","family":"Ordi","sequence":"additional","affiliation":[{"name":"Fonaments Cl\u00ednics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Barcelona Institute for Global Health, 08036 Barcelona, Spain"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Pathology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Gynaecological Cancer Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7832-334X","authenticated-orcid":false,"given":"Angeles","family":"Rovirosa","sequence":"additional","affiliation":[{"name":"Fonaments Cl\u00ednics Department, Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Radiation Oncology Department, Hospital Cl\u00ednic Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), C\/Casanovas 153, 08036 Barcelona, Spain"},{"name":"Gynaecological Cancer Unit, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s11547-022-01455-y","article-title":"EROS 2.0 study: Evaluation of two interventional radiotherapy (brachytherapy) schedules for endometrial cancer: A comparison of late vaginal toxicity rates","volume":"127","author":"Lancellotta","year":"2022","journal-title":"LA Radiol. 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