Outcome analysis of HDR compared to PDR IGABT in locally advanced cervical cancer: a single-center cohort analysis

• Published in: Strahlentherapie und Onkologie Vol. 199; no. 2; pp. 141 - 148
• Main Authors: Hermesse, Johanne, Pleyers, Clémence, Gennigens, Christine, De Cuypere, Marjolein, Lovinfosse, Pierre, Seidel Statistician, Laurence, Coucke, Philippe, Kridelka, Frédéric
• Format: Journal Article Web Resource
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2023; Springer Nature B.V; Springer Science and Business Media Deutschland GmbH
• Subjects: Brachytherapy; Brachytherapy - adverse effects; Cancer; Cervical cancer; Chemoradiotherapy; Cohort analysis; Cohort Studies; Expertise; Female; Human health sciences; Humans; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - etiology; Oncology; Original Article; Radiation therapy; Radiologie, médecine & imagerie nucléaire; Radiology, nuclear medicine & imaging; Radiology, Nuclear Medicine and Imaging; Radiotherapy; Radiotherapy Dosage; Sciences de la santé humaine; Survival; Toxicity; Uterine Cervical Neoplasms - radiotherapy; Brachytherapy; Magnetic resonance imaging; Toxicity; Chemoradiotherapy; Survival; Expertise
• ISSN: 0179-7158; 1439-099X; 1439-099X
• DOI: 10.1007/s00066-022-01982-7

Purpose
This monocentric study aimed to assess the impact of technical advancement in brachytherapy (BT) on local control (LC) and cancer-specific survival (CSS) in locally advanced cervical cancer (LACC).
Methods
Since 2010, 211 patients with LACC have been treated with 45/50.4 Gy or 60 Gy radiochemotherapy (RTCT) followed by image-guided adaptive brachytherapy (IGABT) at the authors’ institution. In 2013, combined intracavitary and interstitial brachytherapy (BT IC/IS) was implemented and in 2018, pulsed-dose-rate BT (PDR-BT) was replaced by high-dose-rate BT (HDR-BT). LC, CSS, and morbidity according to the RTOG/EORTC scoring system were analyzed. Dose–volume parameters for the high-risk clinical target volume (HRCTV) and organs at risk (OAR) were reported.
Results
While 27 (12.8%) patients died of LACC, complete local remission was achieved in 199 (94.3%). Local relapse decreases with a high D95 in the HRCTV (hazard ratio, HR = 0.85,
p
 = 0.0024). D95 in the HRCTV is lower after 60 Gy even if interstitial BT is used. Mean D95 in the HRCTV is 78.2 Gy, 83.3 Gy, and 83.4 Gy with PDR-BT IC, PDR-BT IC/IS, and HDR-BT IC/IS, respectively, after 45/50.4 Gy. D2 cc of OARs is significantly reduced by using interstitial BT. The mean rectum and sigmoid D2 cc are about 61.5 Gy with PDR-BT IC/IS and significantly decreased with HDR-BT IC/IS. This translates into a low fistula incidence. A very low rate of severe gastrointestinal (3.4%) and genitourinary (2.3%) toxicity was observed with HDR-BT IC/IS.
Conclusion
This large monocentric study provides further evidence that implementation of BT IC/IS has an impact on D95 in the HRCTV, LC, and CSS. There are no differences between HDR and PDR in terms of efficacy, D95 in the HRCTV, and toxicity grade ≥ 3.