Prognostic Implications of Uterine Cervical Cancer Regression During Chemoradiation Evaluated by the T-Score in the Multicenter EMBRACE I Study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Jacob Christian Lindegaard
  • Primoz Petric, University of Zurich
  • ,
  • Maximilian Paul Schmid, Medical University of Vienna
  • ,
  • Nicole Nesvacil, Medical University of Vienna
  • ,
  • Christine Haie-Meder, Institut Gustave Roussy
  • ,
  • Lars Ulrik Fokdal
  • ,
  • Alina Emiliana Sturdza, Medical University of Vienna
  • ,
  • Peter Hoskin, Mount Vernon Cancer Centre, Northwood, United Kingdom.
  • ,
  • Umesh Mahantshetty, Tata Memorial Hospital
  • ,
  • Barbara Segedin, University of Ljubljana
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  • Kjersti Bruheim, University of Oslo
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  • Fleur Huang, Cross Cancer Institute
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  • Bhavana Rai, Postgraduate Institute of Medical Education and Research
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  • Rachel Cooper, Leeds Teaching Hospitals NHS Trust
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  • Elzbieta van der Steen-Banasik, Radiotherapiegroep Arnhem
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  • Erik Van Limbergen, KU Leuven
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  • Bradley Rumwell Pieters, University of Amsterdam
  • ,
  • Li Tee Tan, Cambridge University Hospitals NHS Foundation Trust
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  • Remi A. Nout, Leiden University
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  • Astrid Agatha Catharina De Leeuw, Utrecht University
  • ,
  • Kathrin Kirchheiner, Medical University of Vienna
  • ,
  • Sofia Spampinato
  • Ina Jürgenliemk-Schulz, Utrecht University
  • ,
  • Kari Tanderup
  • Christian Kirisits, Medical University of Vienna
  • ,
  • Richard Pötter, Medical University of Vienna

Purpose: A simple scoring system (T-score, TS) for integrating findings from clinical examination and magnetic resonance imaging (MRI) of the primary tumor at diagnosis has shown strong prognostic capability for predicting local control and survival in locally advanced cervical cancer treated with chemoradiation and MRI-guided brachytherapy (BT). The aim was to validate the performance of TS using the multicenter EMBRACE I study and to evaluate the prognostic implications of TS regression obtained during initial chemoradiation. Methods and Materials: EMBRACE I recruited 1416 patients, of whom 1318 were available for TS. Patients were treated with chemoradiation followed by MRI-guided BT. A ranked ordinal scale of 0 to 3 points was used to assess 8 anatomic locations typical for local invasion of cervical cancer. TS was calculated separately at diagnosis (TSD) and at BT (TSBT) by the sum of points obtained from the 8 locations at the 2 occasions. Results: Median TSD and TSBT was 5 and 4, respectively. TS regression was observed in 71% and was an explanatory variable for BT technique (intracavitary vs intracavitary/interstitial) and major dose-volume histogram parameters for BT, such as high-risk clinical target (CTVHR), CTVHR D90 (minimal dose to 90% of the target volume), D2cm3 bladder (minimal dose to the most exposed 2 cm3 of the bladder), and D2cm3 rectum. TS regression (TSBT≤5) was associated with improved local control and survival and with less morbidity compared with patients with TSBT remaining high (>5) despite initial chemoradiation. TS regression was significant in multivariate analysis for both local control and survival when analyzed in consort with already established prognostic parameters related to the patient, disease, and treatment. Conclusions: TS was validated in a multicenter setting and proven to be a strong multidisciplinary platform for integration of clinical findings and imaging with the ability to quantitate local tumor regression and its prognostic implications regarding BT technique, dose-volume histogram parameters, local control, survival, and morbidity.

Original languageEnglish
JournalInternational Journal of Radiation Oncology Biology Physics
Volume113
Issue2
Pages (from-to)379-389
Number of pages11
ISSN0360-3016
DOIs
Publication statusPublished - Jun 2022

    Research areas

  • CARCINOMA, CLINICAL EXAMINATION, DELINEATION, FIGO, GUIDED ADAPTIVE BRACHYTHERAPY, IMPACT, INTRACAVITARY, MRI, SURVIVAL, VOLUME

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