Lars Fokdal1, Alina Sturdza2, Renaud Mazeron3, Christine Haie-Meder3, Li Tee Tan4, Charles Gillham5, Barbara Šegedin6, Ina Jürgenliemk-Schultz7, Christian Kirisits2, Peter Hoskin8, Richard Pötter2, Jacob C Lindegaard9, Kari Tanderup9. 1. Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: Larfok@rm.dk. 2. Department of Radiation Oncology, Medical University of Vienna, Austria. 3. Radiation Oncology Department, Gustave Roussy Cancer Campus Grand Paris, France. 4. Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Trust, United Kingdom. 5. Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland. 6. Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia. 7. Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands. 8. Cancer Centre, Mount Vernon Hospital, London, United Kingdom. 9. Department of Oncology, Aarhus University Hospital, Denmark.
Abstract
BACKGROUND AND PURPOSE: Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicators. The aim of this analysis was to evaluate the impact on local control and late morbidity of application of combined IS/IC brachytherapy in a large multicentre population. MATERIAL/ METHODS: 610 patients with LACC from the retroEMBRACE study were included. Patients were divided into an IC group (N=310) and an IC/IS group (N=300). The IC/IS group was defined from the time point, when a centre performed IC/IS brachytherapy in more than 20% of cases. RESULTS: With systematic usage of IC/IS the D90 of CTVHR increased from 83±14Gy to 92±13Gy (p<0.01). No difference in doses to organs at risk was found. The 3-year local control rate in patients having a CTVHR volume⩾30cm3 was 10% higher (p=0.02) in the IC/IS group. No difference was found for CTVHR<30cm3 (p=0.50). No significant difference in late morbidity was found between the IC/IS group and IC group. CONCLUSION: Combined IC/IS brachytherapy improves the therapeutic ratio in LACC by enabling a tumour specific dose escalation resulting in significantly higher local control in large tumours without adding treatment related late morbidity.
BACKGROUND AND PURPOSE: Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicators. The aim of this analysis was to evaluate the impact on local control and late morbidity of application of combined IS/IC brachytherapy in a large multicentre population. MATERIAL/ METHODS: 610 patients with LACC from the retroEMBRACE study were included. Patients were divided into an IC group (N=310) and an IC/IS group (N=300). The IC/IS group was defined from the time point, when a centre performed IC/IS brachytherapy in more than 20% of cases. RESULTS: With systematic usage of IC/IS the D90 of CTVHR increased from 83±14Gy to 92±13Gy (p<0.01). No difference in doses to organs at risk was found. The 3-year local control rate in patients having a CTVHR volume⩾30cm3 was 10% higher (p=0.02) in the IC/IS group. No difference was found for CTVHR<30cm3 (p=0.50). No significant difference in late morbidity was found between the IC/IS group and IC group. CONCLUSION: Combined IC/IS brachytherapy improves the therapeutic ratio in LACC by enabling a tumour specific dose escalation resulting in significantly higher local control in large tumours without adding treatment related late morbidity.
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