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

• Published in: Radiotherapy and oncology 2021-04, Vol.157, p.24-31
• Main Authors: Petric, Primoz, Lindegaard, Jacob C., Sturdza, Alina, Fokdal, Lars, Kirchheiner, Kathrin, Tan, Li T., Schmid, Maximilian P., Haie-Meder, Christine, Jürgenliemk-Schulz, Ina M., van Limbergen, Erik, Hoskin, Peter, Gillham, Charles, Tharavichitkul, Ekkasit, Mahantshetty, Umesh, Villafranca, Elena, Tanderup, Kari, Kirisits, Christian, Pötter, Richard
• Format: Article
• Language: English
• Subjects: Brachytherapy; Cervix cancer; Chemoradiotherapy; Female; Humans; Image guided brachytherapy; Middle Aged; Neoplasm Staging; Radiotherapy Dosage; Treatment Outcome; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2021.01.005

•Local and pelvic control in FIGO1994 stage IB were ≥95% with acceptable morbidity.•We found no isolated local relapse. Pelvic failure occurred in 3%. Most relapses were systemic.•Results of modern brachytherapy in early cervical cancer parallel those of modern surgery. 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). 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. 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%. 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.