Clinical Outcomes and Toxicity of CT-guided High Dose-rate Brachytherapy in Women With Locally-advanced Cervical Cancer

Vitaliana DE Sanctis; Giuseppe Facondo; Gianluca Vullo; Dimitri Anzellini; Giuseppe Sanguineti; Alessia Nardangeli; Luca Marmiroli; Francesca Tortoreto; Piercarlo Gentile; Ivan Annessi; Vittorio Donato; Cinzia Chiostrini; Vincenzo Tombolini; Francesca DE Felice; Maurizio Valeriani; Mattia Falchetto Osti

doi:10.21873/cdp.10201

Clinical Outcomes and Toxicity of CT-guided High Dose-rate Brachytherapy in Women With Locally-advanced Cervical Cancer

Cancer Diagn Progn. 2023 Mar 3;3(2):194-200. doi: 10.21873/cdp.10201. eCollection 2023 Mar-Apr.

Authors

Vitaliana DE Sanctis¹, Giuseppe Facondo¹, Gianluca Vullo¹, Dimitri Anzellini¹, Giuseppe Sanguineti², Alessia Nardangeli², Luca Marmiroli³, Francesca Tortoreto³, Piercarlo Gentile⁴, Ivan Annessi⁴, Vittorio Donato⁵, Cinzia Chiostrini⁵, Vincenzo Tombolini⁶, Francesca DE Felice⁶, Maurizio Valeriani¹, Mattia Falchetto Osti¹

Affiliations

¹ Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy.
² Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
³ U.O.C. Radiotherapy, S. Giovanni Calibita Fatebenefratelli Hospital - Amethyst Radioterapia Italia, Rome, Italy.
⁴ Department of Radiation Oncology, San Pietro Fatebenefratelli (FBF), Rome, Italy.
⁵ Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
⁶ Department of Radiotherapy, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.

Abstract

Background/aim: To evaluate the outcome and toxicities in patients with locally advanced cervical cancer (LACC) treated with radiochemotherapy and intracavitary brachytherapy.

Patients and methods: This study included 67 patients with LACC treated between 2010 and 2018. The most represented stage was FIGO IIB. The patients were treated with external beam radiotherapy (EBRT) to the pelvis and boost to the cervix and parametrials. Concomitant chemotherapy (CHT) with cisplatin (CDDP) 40 mg/mq was planned. Subsequently, the patients underwent CT-based endouterine brachytherapy (BT). The response was evaluated at 3 months with PET-CT and/or pelvic magnetic resonance imaging (MRI). Since then, the patients have been followed with clinical instrumental controls every 4 months for the first 2 years and every 6 months for the following 3 years. Local response was assessed with pelvic MRI and/or PET-CT scan at the end of intracavitary BT) according to RECIST 1.1 criteria.

Results: The median duration of treatment was 55 days (range=40-73 days). The prescription dose to the planning target volume (PTV) was delivered in 25 to 30 (median 28) daily fractions. The EBRT median dose to the pelvis and gross tumor volume were 50.4 Gy (range=45-56.25) and 61.6 Gy (range=45-70.4), respectively. The 1-year, 2-year, 3-year, and 5-year overall survival rates were 92.44%, 80.81%, 78.84%, and 76.45% respectively. The actuarial 1-year, 2-year, 3-year, and 5-year disease-free survival rates were 89.5%, 83.6%, 81%, and 78.2% respectively.

Conclusion: This study analyzed acute and chronic toxicity, survival, and local control in cervical cancer patients treated with IMRT followed by CT-planned high dose rate-brachytherapy. Patients demonstrated satisfactory outcomes and incidence of acute and late toxicities.

Keywords: Cervix; HDR-BT; LACC; brachytherapy; radiotherapy.