Treatment outcomes of MRI-guided adaptive brachytherapy in patients with locally advanced cervical cancer: institutional experiences

• Published in: Strahlentherapie und Onkologie Vol. 198; no. 9; pp. 783 - 791
• Main Authors: Vojtíšek, Radovan, Hošek, Petr, Sukovská, Emília, Kovářová, Petra, Baxa, Jan, Ferda, Jiří, Fínek, Jindřich
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2022; Springer Nature B.V
• Subjects: Cancer; Cervical cancer; Clinical outcomes; Magnetic resonance imaging; Medicine; Medicine & Public Health; Oncology; Original Article; Radiation therapy; Radiotherapy; Toxicity; Uterovaginal brachytherapy; Late toxicity; Overall survival; Local control; Chemoradiotherapy
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-021-01887-x

Purpose Image-guided adaptive brachytherapy (IGABT) is currently state of the art in the comprehensive treatment of patients with cervical cancer. Here, we report mature clinical data regarding IGABT of cervical cancer in a large patient sample, examining clinical outcomes, manifestations of late toxicities, and dosimetric findings. Methods Between May 2012 and October 2020, we performed a total of 544 uterovaginal IGABT applications in 131 consecutive patients with biopsy-proven cervical carcinoma not suitable for surgery. The median duration of follow-up was 43 months. Results The estimated 3‑, 4‑, and 5‑year LC rates were 88.3% (95% confidence interval [CI] 81.1–95.5), 86.9% (95% CI 78.5–95.3), and 85.5% (95% CI 76–95%), respectively. The 3‑, 4‑, and 5‑year OS estimates were 72.66% (95% CI 63.64–81.69%), 68.9% (95% CI 59.15–78.66%), and 63.96% (95% CI 52.94–74.97%), respectively. Patients who received ≥ 5 cycles of chemotherapy had statistically significantly better 3‑year recurrence-free survival (RFS) compared to patients who completed <5 cycles (79.07% [95% CI 60.81–97.34] vs. 58.10% [95% CI 47.22–68.98]; p  = 0.0185). We recorded manifestations of genitourinary and gastrointestinal toxicity grade ≥3 in 6.9% and 5.3%, respectively. Conclusion Our mature long-term data on the treatment patients with locally advanced cervical cancer show that excellent treatment outcomes can be achieved with MRI-based IGABT, as well as acceptable late morbidity.