Dose-response relationships of intestinal organs and excessive mucus discharge after gynaecological radiotherapy
Journal article, 2021

Background The study aims to determine possible dose-volume response relationships between the rectum, sigmoid colon and small intestine and the ‘excessive mucus discharge’ syndrome after pelvic radiotherapy for gynaecological cancer. Methods and materials 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 ‘excessive mucus discharge’ 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. Results The small intestine was found to have steep dose-response curves, having estimated dose-response parameters: γ : 1.28, 1.23, 1.32, D : 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. Conclusion An association was found between the mean dose to the small intestine and the occurrence of ‘excessive mucus discharge’. When trying to reduce and even eliminate the incidence of ‘excessive mucus discharge’, it would be useful and important to separately delineate the small intestine and implement the dose-response estimations reported in the study.


Eleftheria Alevronta

University of Gothenburg

Viktor Skokic

University of Gothenburg

Gail Dunberger

Ersta Sköndal University College

Cecilia Bull

University of Gothenburg

Karin Bergmark

University of Gothenburg

Rebecka Jörnsten

Chalmers, Mathematical Sciences, Applied Mathematics and Statistics

Gunnar Steineck

Karolinska Institutet

University of Gothenburg


1932-6203 (ISSN)

Vol. 16 4 April e0250004

Subject Categories

Gastroenterology and Hepatology

Radiology, Nuclear Medicine and Medical Imaging

Cancer and Oncology





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5/6/2021 1