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Tytuł:
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Results of image guided brachytherapy for stage IB cervical cancer in the RetroEMBRACE study.
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Autorzy:
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Petric P; Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia; Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: .
Lindegaard JC; Department of Oncology, Aarhus University Hospital, Denmark.
Sturdza A; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
Fokdal L; Department of Oncology, Aarhus University Hospital, Denmark.
Kirchheiner K; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
Tan LT; Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke's Hospital, Cambridge University Hospitals, United Kingdom.
Schmid MP; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
Haie-Meder C; Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
Jürgenliemk-Schulz IM; Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands.
van Limbergen E; Department of Radiation Oncology, University Hospitals Leuven, Belgium.
Hoskin P; Mount Vernon Cancer Centre, Northwood, United Kingdom.
Gillham C; Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland.
Tharavichitkul E; Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand.
Mahantshetty U; Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, India.
Villafranca E; Department of Radiation Oncology, Complejo Hospitalario de Navarra, Spain.
Tanderup K; Department of Oncology, Aarhus University Hospital, Denmark.
Kirisits C; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
Pötter R; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria.
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Źródło:
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Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2021 Apr; Vol. 157, pp. 24-31. Date of Electronic Publication: 2021 Jan 19.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: Limerick : Elsevier Scientific Publishers
Original Publication: Amsterdam : Elsevier Science Publishers, c1983-
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MeSH Terms:
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Brachytherapy*
Uterine Cervical Neoplasms*/drug therapy
Uterine Cervical Neoplasms*/radiotherapy
Chemoradiotherapy ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Radiotherapy Dosage ; Treatment Outcome
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Contributed Indexing:
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Keywords: Brachytherapy; Cervix cancer; Image guided brachytherapy
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Entry Date(s):
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Date Created: 20210121 Date Completed: 20210423 Latest Revision: 20210423
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Update Code:
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20240105
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DOI:
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10.1016/j.radonc.2021.01.005
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PMID:
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33476724
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Objective: Multiple treatment options are used in early local-stage cervical cancer, including combinations of surgery with neoadjuvant/adjuvant radiotherapy and chemotherapy. Our aim was to determine the outcome for definitive chemoradiation with image guided brachytherapy (IGBT).
Methods: FIGO 1994 staging system was used in our study. We included 123 patients with stage IB cervical cancer, treated at 12 centers with external beam radiotherapy (EBRT) ± Chemotherapy and IGBT. Three- and 5-year actuarial local control (LC), pelvic control (PC), overall survival (OS), cancer-specific survival (CSS) and late morbidity (CTCAE v 3.0) were computed.
Results: Median age was 48 (23-82) years. FIGO 1994 stage distribution was: IB1 68% and IB2 32%; 41% of the entire cohort had nodal metastases and 73% squamous-cell carcinoma. MRI-based tumor size was >40 mm in 63%. Median EBRT dose was 45 (40-50) Gy; 84% received chemotherapy. At IGBT, mean CTV-HR D90 was 93 ± 17 Gy (EQD2 10 ). D2cc for bladder was 76 ± 14 Gy, rectum 66 ± 11 Gy, sigmoid 66 ± 10 Gy, bowel 67 ± 7 Gy (EQD2 3 ). At 43-months median follow-up, 9% of patients had systemic, 6% paraaortic, 3% pelvic-nodal and 2% local failure. Five-year LC was 98%, PC 96%, CSS 90%, OS 83%. Intestinal G3--4 morbidity was 8%, urinary 7% and vaginal 0%.
Conclusions: Chemoradiation with IGBT for FIGO 1994 stage IB cervical cancer leads to excellent loco-regional control with limited morbidity. In IB node-negative disease, it can be regarded equivalent to surgery in terms of oncologic outcome. In tumors with unfavorable pre-treatment characteristics, chemoradiation is the first choice to avoid combining surgery with adjuvant therapy.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021. Published by Elsevier B.V.)
