Cervical cancer brachytherapyImpact of treatment time and dose escalation on local control in locally advanced cervical cancer treated by chemoradiation and image-guided pulsed-dose rate adaptive brachytherapy
Section snippets
Patient selection
Clinical and dosimetric data of patients with locally advanced cervical cancer defined as FIGO (Fédération International de Gynécologie Obstétrique) stage 1B1 with positive pelvic nodes ± paraaortic nodes, 1B2-IVA, were retrospectively reviewed. Patients were selected from the department database. Those treated with definitive radiotherapy and curative intent were included. The patients who were referred only for BT and never followed after the completion of their treatment were excluded (n = 9).
Treatment
Population
Two hundred and twenty-five patients fulfilled the inclusion criteria. The median follow-up was 39.0 months. Population characteristics are depicted in Table 1. The majority of the tumors were stage II according to the FIGO classification (52.4%, 118/225). Twenty-eight percent were stage IB (62/225), whereas 12.4% were stage III (28/225) and the remaining 3.1% stage IVA (7/225). Forty-three percent of the patients had lymph node involvement (97/225). Eighty-four of the patients had a PET-CT in
Discussion
Several studies have reported the detrimental effect of treatment duration on local control before the advent of chemoradiation and IGABT. Fyles et al. were the first to report a consistent loss of local control, approximately 1% per day of treatment prolongation beyond 30 days [11]. In this series, the majority of the patients received hypofractionated EBRT (45 Gy in 20 fractions) followed by a single BT fraction. Those results were later on confirmed by Girinsky et al., with a threshold of 52
Conclusions
Treatment intensification does not overcome the negative effect of overall treatment time, which remains an independent prognosis factor in the era of image-guided adaptive BT following concomitant chemoradiation, alongside the HR-CTV volume. D90 to both IR and HR-CTV are also predominant in the probability of local control. Dose–effect relationships suggest that the prescribed D90 HR-CTV should be increased to overcome adverse prognosis factors, or conversely could be safely decreased in good
Conflict of interest
None.
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