{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:05:08Z","timestamp":1760058308987,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Endometrial cancer is the most common gynecologic malignancy in developed countries, with obesity recognized as a major risk factor contributing to its incidence. The rising prevalence of obesity has significant implications for treatment planning, particularly in radiation therapy approaches such as high-dose-rate (HDR) vaginal cuff brachytherapy, which is commonly used as adjuvant therapy in early-stage endometrial carcinoma. Body Mass Index (BMI) is a key factor in brachytherapy, as increased adiposity may alter dosimetric parameters, affecting radiation distribution and doses received by organs at risk (OARs). Understanding the correlation between BMI and radiation dose to OARs is essential for optimizing treatment planning and minimizing adverse effects. Identifying dose variations across different BMI categories may help refine patient-specific brachytherapy approaches to ensure both efficacy and safety. Objectives: This study aims to investigate the influence of Body Mass Index (BMI) on the doses received by organs at risk (OAR) during high-dose-rate (HDR) vaginal cuff brachytherapy in patients diagnosed with early-stage endometrial carcinoma. Understanding the relationship between BMI and OAR doses could enhance treatment planning and minimize complications. Methods: We collected brachytherapy data for 242 endometrial cancer patients treated with adjuvant HDR vaginal cuff brachytherapy. The patients were categorized based on their BMI into normal weight, overweight, and obese groups. Dosimetric data were collected for OARs, including the bladder, rectum, and sigmoid colon, and also for dose fractionation, D90%, and the active length of the brachytherapy cylinder. The analysis included comparing the doses received by each organ across different BMI categories using appropriate statistical methods. Results: Preliminary findings indicated a significant variation in the doses to OARs correlating with BMI classifications. Obese patients exhibited slightly higher mean doses to the rectum and sigmoid compared to those with a normal BMI. The statistical analysis demonstrated that as BMI increased, the dose to these organs at risk also tended to increase, suggesting a need for adjusted treatment planning strategies in this population. Conclusions: Obesity is a key concern in endometrial cancer patients, with higher BMI linked to slightly increased doses to the rectum and sigmoid, though treatment remained homogeneously delivered. Future prospective clinical studies are essential to explore the relationship between these dosimetric findings, specifically the correlation between higher BMI, increased doses to organs at risk (OARs), and late treatment-related toxicities. This research is needed to better understand the long-term implications and to optimize therapeutic outcomes.<\/jats:p>","DOI":"10.3390\/diagnostics15070795","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T07:25:00Z","timestamp":1742541900000},"page":"795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating the Influence of Body Mass Index on Organs at Risk Doses for Adjuvant High-Dose-Rate Vaginal Cuff Brachytherapy in Patients with Early-Stage Endometrial Carcinoma: A Single-Center Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9260-3994","authenticated-orcid":false,"given":"Alexandra Timea","family":"Kirsch-Mangu","sequence":"first","affiliation":[{"name":"Department of Oncology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7968-0040","authenticated-orcid":false,"given":"Diana Cristina","family":"Pop","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0307-7111","authenticated-orcid":false,"given":"Alexandru","family":"\u021aipcu","sequence":"additional","affiliation":[{"name":"Department of Oncology, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei-Rare\u0219","family":"Avasi","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Ordeanu","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8865-2913","authenticated-orcid":false,"given":"Ovidiu Florin","family":"Coza","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Irimie","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. I. Chiricut\u0103\u201d Oncology Institute, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.5114\/pm.2016.61186","article-title":"An update of the classical Bokhman\u2019s dualistic model of endometrial cancer","volume":"2","author":"Danielska","year":"2016","journal-title":"Menopausal Rev."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alexa, M., Hasenburg, A., and Battista, M.J. (2021). The TCGA Molecular Classification of Endometrial Cancer and Its Possible Impact on Adjuvant Treatment Decisions. Cancers, 13.","DOI":"10.3390\/cancers13061478"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/S0090-8258(03)00232-4","article-title":"The effect of body mass index on clinical\/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer","volume":"90","author":"Everett","year":"2003","journal-title":"Gynecol. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1038\/sj.bjc.6604313","article-title":"Body mass, diabetes and smoking, and endometrial cancer risk: A follow-up study","volume":"98","author":"Lindemann","year":"2008","journal-title":"Br. J. Cancer."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4225","DOI":"10.1200\/JCO.2016.69.4638","article-title":"Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment","volume":"34","author":"Onstad","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/S0140-6736(15)00130-0","article-title":"Endometrial cancer","volume":"387","author":"Morice","year":"2016","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ygyno.2013.06.037","article-title":"Risk-scoring system for the individualized prediction of lymphatic dissemination in patients with endometrioid endometrial cancer","volume":"131","author":"AlHilli","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1002\/(SICI)1097-0142(19960315)77:6<1115::AID-CNCR17>3.0.CO;2-4","article-title":"Pathologic models to predict outcome for women with endometrial adenocarcinoma: The importance of the distinction between surgical stage and clinical stage\u2014A Gynecologic Oncology Group study","volume":"77","author":"Zaino","year":"1996","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e631","DOI":"10.1016\/j.ijrobp.2011.04.013","article-title":"Fifteen-Year Radiotherapy Outcomes of the Randomized PORTEC-1 Trial for Endometrial Carcinoma","volume":"81","author":"Creutzberg","year":"2011","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1136\/ijgc-2020-001929","article-title":"PORTEC-4a: International randomized trial of molecular profile-based adjuvant treatment for women with high-intermediate risk endometrial cancer","volume":"30","author":"Horeweg","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.brachy.2016.04.005","article-title":"American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review","volume":"16","author":"Harkenrider","year":"2017","journal-title":"Brachytherapy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.brachy.2015.09.012","article-title":"Vaginal brachytherapy for postoperative endometrial cancer","volume":"15","author":"Harkenrider","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.ygyno.2005.02.021","article-title":"Vaginal brachytherapy alone: An alternative to adjuvant whole pelvis radiation for early stage endometrial cancer","volume":"97","author":"Jolly","year":"2005","journal-title":"Gynecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.ijrobp.2004.12.079","article-title":"Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer: A randomized study of two dose-per-fraction levels","volume":"62","author":"Sorbe","year":"2005","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0360-3016(98)00292-2","article-title":"High-dose-rate brachytherapy alone post-hysterectomy for endometrial cancer","volume":"42","author":"MacLeod","year":"1998","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.ygyno.2012.07.111","article-title":"A novel low dose fractionation regimen for adjuvant vaginal brachytherapy in early stage endometrioid endometrial cancer","volume":"127","author":"Townamchai","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.brachy.2005.02.002","article-title":"Vaginal lymphatic channel location and its implication for intracavitary brachytherapy radiation treatment","volume":"4","author":"Choo","year":"2005","journal-title":"Brachytherapy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.brachy.2011.08.005","article-title":"American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy","volume":"11","author":"Small","year":"2012","journal-title":"Brachytherapy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.brachy.2014.07.002","article-title":"Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma","volume":"13","author":"Gill","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/S0360-3016(00)00689-1","article-title":"The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the endometrium","volume":"48","author":"Nag","year":"2000","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.brachy.2019.02.008","article-title":"Compendium of fractionation choices for gynecologic HDR brachytherapy\u2014An American Brachytherapy Society Task Group Report","volume":"18","author":"Albuquerque","year":"2019","journal-title":"Brachytherapy"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.brachy.2013.12.002","article-title":"Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning","volume":"13","author":"Boyle","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.radonc.2021.05.010","article-title":"IBS-GEC ESTRO-ABS recommendations for CT based contouring in image guided adaptive brachytherapy for cervical cancer","volume":"160","author":"Mahantshetty","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_25","unstructured":"(2000). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation, World Health Organization."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.brachy.2010.10.005","article-title":"Should the organs at risk be contoured in vaginal cuff brachytherapy?","volume":"10","author":"Holloway","year":"2011","journal-title":"Brachytherapy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.brachy.2013.11.006","article-title":"Dose accumulation during vaginal cuff brachytherapy based on rigid\/deformable registration vs. single plan addition","volume":"13","author":"Sabater","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"473","DOI":"10.4143\/crt.2014.115","article-title":"Body Mass Index and Doses at Organs at Risk in a Mediterranean Population Treated with Postoperative Vaginal Cuff Brachytherapy","volume":"47","author":"Sabater","year":"2014","journal-title":"Cancer Res. Treat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0360-3016(99)00330-2","article-title":"A simple method of obtaining equivalent doses for use in HDR brachytherapy","volume":"46","author":"Nag","year":"2000","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_30","unstructured":"(2013). Prescribing, Recording, and Reporting Brachytherapy for Cancer of the Cervix. J. ICRU, 13, 1."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/795\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:57:40Z","timestamp":1760029060000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,21]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["diagnostics15070795"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15070795","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,3,21]]}}}