Results of image guided brachytherapy for stage IB cervical cancer in the RetroEMBRACE study

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  • Primoz Petric, Institute of Oncology Ljubljana
  • ,
  • Jacob C. Lindegaard
  • Alina Sturdza, Medical University of Vienna
  • ,
  • Lars Fokdal
  • ,
  • Kathrin Kirchheiner, Medical University of Vienna
  • ,
  • Li T. Tan, Cambridge University Hospitals NHS Foundation Trust
  • ,
  • Maximilian P. Schmid, Medical University of Vienna
  • ,
  • Christine Haie-Meder, Institut Gustave Roussy
  • ,
  • Ina M. Jürgenliemk-Schulz, Utrecht University
  • ,
  • Erik van Limbergen, KU Leuven
  • ,
  • Peter Hoskin, Mount Vernon Hospital
  • ,
  • Charles Gillham, St Luke's Hospital, Dublin
  • ,
  • Ekkasit Tharavichitkul, Chiang Mai University
  • ,
  • Umesh Mahantshetty, Homi Bhabha National Institute
  • ,
  • Elena Villafranca, Complejo Hospitalario
  • ,
  • Kari Tanderup
  • Christian Kirisits, Medical University of Vienna
  • ,
  • Richard Pötter, Medical University of Vienna

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: FIGO1994 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. FIGO1994 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 (EQD210). D2cc for bladder was 76 ± 14 Gy, rectum 66 ± 11 Gy, sigmoid 66 ± 10 Gy, bowel 67 ± 7 Gy (EQD23). 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 FIGO1994 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.

OriginalsprogEngelsk
TidsskriftRadiotherapy and Oncology
Vol/bind157
Sider (fra-til)24-31
Antal sider8
ISSN0167-8140
DOI
StatusUdgivet - apr. 2021

Bibliografisk note

Funding Information:
Dr. Petric reports personal fees from Varian Medical Systems, personal fees from Elekta, outside the submitted work. Dr. Lindegaard reports grants from Varian Medical systems, outside the submitted work. Dr. Sturdza reports grants from Elekta, grants from Varian Medical System, personal fees from Elekta, grants from Stiftung Philanthropie Österreich, outside the submitted work. Dr. Schmid reports grants from Elekta, Varian, during the conduct of the study; personal fees from Elekta, outside the submitted work. Dr. Tanderup reports grants from Varian Medical Systems, grants from Elekta, during the conduct of the study; grants from Novo Nordisk foundation, grants from Danish Cancer Society, outside the submitted work. Dr. Kirisits reports grants from Elekta AB, grants from Varian Medical Systems, during the conduct of the study; personal fees and non-financial support from Elekta AB, outside the submitted work. Dr. Pötter reports grants from Elekta, grants from Varian Medical System, outside the submitted work.

Funding Information:
RetroEmbrace study was supported by grants from Elekta and Varian Medical Systems .

Publisher Copyright:
© 2021

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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