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Risk Factors for Local Failure Following Chemoradiation and Magnetic Resonance Image-Guided Brachytherapy in Locally Advanced Cervical Cancer: Results From the EMBRACE-I Study

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

DOI

  • Maximilian P. Schmid, Medical University of Vienna
    • ,
  • Jacob C. Lindegaard
  • Umesh Mahantshetty, Tata Memorial Hospital
    • ,
  • Kari Tanderup
  • Ina Jürgenliemk-Schulz, Utrecht University
    • ,
  • Christine Haie-Meder, Institut Gustave Roussy
    • ,
  • Lars U. Fokdal
    • ,
  • Alina Sturdza, Medical University of Vienna
    • ,
  • Peter Hoskin, East and North Hertfordshire NHS Trust
    • ,
  • Barbara Segedin, University of Ljubljana
    • ,
  • Kjersti Bruheim, University of Oslo
    • ,
  • Fleur Huang, Cross Cancer Institute
    • ,
  • Bhavana Rai, Postgraduate Institute of Medical Education and Research
    • ,
  • Rachel Cooper, Leeds Teaching Hospitals NHS Trust
    • ,
  • Elzbieta van der Steen-Banasik, Netherlands Cancer Institute
    • ,
  • Erik Van Limbergen, KU Leuven
    • ,
  • Bradley R. Pieters, University of Amsterdam
    • ,
  • Primoz Petric, University of Ljubljana
    • ,
  • Dariga Ramazanova, Medical University of Vienna
    • ,
  • Robin Ristl, Medical University of Vienna
    • ,
  • Sadhana Kannan, Tata Memorial Hospital
    • ,
  • Rohini Hawaldar, Tata Memorial Hospital
    • ,
  • Stefan Ecker, Medical University of Vienna
    • ,
  • Kathrin Kirchheiner, Medical University of Vienna
    • ,
  • Li Tee Tan, Cambridge University Hospitals NHS Foundation Trust
    • ,
  • Remi Nout, Leiden University
    • ,
  • Nicole Nesvacil, Medical University of Vienna
    • ,
  • Astrid de Leeuw, Utrecht University
    • ,
  • Richard Pötter, Medical University of Vienna
    • ,
  • Christian Kirisits, Medical University of Vienna
    • ,
  • EMBRACE Collaborative Group

PURPOSE: To report clinical and treatment characteristics, remission and failure patterns, and risk factors for local failure (LF) from the EMBRACE-I study. MATERIALS AND METHODS: EMBRACE-I was a prospective, observational, multicenter cohort study on magnetic resonance imaging-based image-guided adaptive brachytherapy (MR-IGABT) in locally advanced cervical cancer. Treatment consisted of external beam radiotherapy, concurrent chemotherapy, and MR-IGABT. LF was defined as progressive or recurrent disease in the cervix, uterus, parametria, pelvic wall, or vagina. Competing risk analysis was used to estimate local tumor control (LC) and Cox proportional regression models for multivariable analysis and dose-response analysis. RESULTS: One thousand three hundred eighteen patients with a median follow-up of 52 months were available for this analysis. Eighty-one patients had persistent disease 3 months after end of treatment. Of those, 60 patients achieved LC at 6-9 months without further treatment, whereas 21 patients had progressive disease. In addition, 77 patients developed a local recurrence after complete remission comprising a total number of 98 LFs. LFs were located inside the MR-IGABT target volumes in 90% of patients with LF. In multivariable analysis, histology, minimal dose to 90% of high-risk clinical target volume (CTVHR), maximum tumor dimension, CTVHR > 45 cm3, overall treatment time, tumor necrosis on magnetic resonance imaging at diagnosis, uterine corpus infiltration at diagnosis and at MR-IGABT, and mesorectal infiltration at MR-IGABT had significant impact on LF. Dose-response analysis showed that a minimal dose to 90% of 85 Gy to the CTVHR led to 95% (95% CI, 94 to 97) LC 3 years postintervention for squamous cell in comparison to 86% (95% CI, 81 to 90) for adeno/adenosquamous carcinoma histology. CONCLUSION: The present study demonstrates the safety and validity of the GYN GEC-ESTRO/ICRU-89 target concept and provides large-scale evidence for dose prescription and new risk factors for LF in MR-IGABT in locally advanced cervical cancer.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Oncology
Vol/bind41
Nummer10
Sider (fra-til)1933-1942
Antal sider10
ISSN0732-183X
DOI
StatusUdgivet - apr. 2023

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