Int J Radiat Oncol Biol Phys. 2023 Aug 14:S0360-3016(23)07744-1. doi: 10.1016/j.ijrobp.2023.07.046. Online ahead of print.
ABSTRACT
OBJECTIVE: To examine the benefit of an intensive locoregional treatment including an image-guided adaptive brachytherapy (IGABT) among cervical cancer patients with extrapelvic extension.
PATIENTS AND METHODS: Medical records of consecutive patients with a metastatic cervical cancer and receiving an external beam radiotherapy (EBRT) and IGABT boost in XXXXXX XXXXXX as part of their first line of treatment were examined. Depending on tumor sites, patients received a pelvic +/- para-aortic EBRT. For those with visceral or supradiaphragmatic lymph node metastases, chemoradiation was delivered after usually 3 cycles of chemotherapy. All patients received a brachytherapy boost, guided by magnetic resonance imaging and aimed at increasing the dose to the high risk clinical target volume (CTVHR). Local control, patient overall (OS), progression-free (PFS) survival and radiotherapy-related side effects were examined and prognostic factors were searched.
RESULTS: 164 patients were included, 76.2% had para-aortic lymph node extension without distant metastasis (N2) and 23.8% had distant metastatic sites (M1). There was not statistically significant difference in survival between both groups. With a median follow-up of 36 months, OS, PFS, and LC at 3 years were 55.5% (CI95%: 48-64), 40.6% (CI95%: 38-54), and 90% (CI95%: 85-96), respectively. In multivariate analysis, a D90CTVHR dose ≥80 Gy was significant for better OS (HR=0.96, 95%CI: 0.94-0.98, p<0.001). Most toxicities were mild to moderate, with 2% of grade 3 late urinary toxicity, 7% late grade 2 vaginal sequelae, and one grade 3 proctitis. During follow-up, rectovaginal fistula occurred in two patients without local relapse.
CONCLUSION: IGABT permits dose escalation and high LC rates for cervical cancer patients with extrapelvic extension. Dose/effect relationships for survival were shown. Because of high frequency of distant events, systemic intensification should be tested more specifically among these patients.
PMID:37586615 | DOI:10.1016/j.ijrobp.2023.07.046
