Locally advanced cervical cancer: how the improvement in techniques in external beam radiotherapy and brachytherapy impacts on survival outcomes and long-term toxicities

Fernando Barbera; Francesco Frassine; Giulia Volpi; Barbara Ghedi; Nadia Pasinetti

doi:10.1007/s11547-023-01705-7

Locally advanced cervical cancer: how the improvement in techniques in external beam radiotherapy and brachytherapy impacts on survival outcomes and long-term toxicities

Radiol Med. 2023 Dec;128(12):1542-1552. doi: 10.1007/s11547-023-01705-7. Epub 2023 Aug 28.

Authors

Fernando Barbera¹, Francesco Frassine¹, Giulia Volpi², Barbara Ghedi³, Nadia Pasinetti⁴

Affiliations

¹ Radiation Oncology Department, University of Brescia, Spedali Civili of Brescia. P.le Spedali Civili, 1, 24123, Brescia, Italy.
² Radiation Oncology Department, University of Brescia, Spedali Civili of Brescia. P.le Spedali Civili, 1, 24123, Brescia, Italy. g.volpi50@gmail.com.
³ Department of Health Physics, Spedali Civili Hospital, Brescia, Lombardia, Italy.
⁴ Radiation Oncology Department, ASST Valcamonica Esine and University of Brescia, Brescia, Italy.

PMID: 37640897
DOI: 10.1007/s11547-023-01705-7

Abstract

Background: Platinum-based chemoradiotherapy and brachytherapy are the standard treatment for locally advanced cervical cancer. Reported long-term outcomes for treated with both IMRT and 3D-Image-guided-adaptive brachytherapy are lacking.

Methods: This retrospective study included 165 patients with FIGO Stage IB-IVB cervical cancer, treated with chemoradiotherapy in combination with brachytherapy. External beam radiotherapy was delivered as IMRT/VMAT/TOMO helical or 3DCRT. The intracavitary brachytherapy treatment (ICBT) was performed using two different planning system (with or without optimization).

Results: Among the patient subgroups, comprising those who received IMRT/VMAT/Tomo helical and 3DCRT, as well as those who underwent ICBT planning optimization and those who did not, homogeneity was observed in terms of age, performance status, T stage, N status, TNM stage, and histology. With a median follow-up time of 60.5 months, the 5-year overall survival (OS) in the 3DCRT and IMRT groups was 74.9% and 92.8%, respectively (p = 0.033). The 5-year OS in the ICBT planning optimization group was 93.7%, compared to 75% in the non-optimization group (p = 0.014). Regarding late radiation toxicities, patients in the IMRT group had a lower incidence of chronic rectal toxicity compared to those in the 3DCRT group (6.5% vs. 34.1%, p = 0.001). The group with ICBT planning optimization had a lower incidence of late urinary toxicities (10.4%) compared to the non-optimized ICBT planning group (18.2%, p = 0.012). Similarly, the ICBT planning optimization group had a lower incidence of late rectal toxicity (6.5% with 80% grade 1 and 20% grade 2) compared to the non-optimized ICBT planning group (34.1%, p = 0.001).

Conclusion: In this series, the group of patients receiving optimized ICBT had an advantage in terms of OS and CSS suggesting that the use of new Treatment Planning Systems associated with 3D imaging, improves the long-term survival. Additionally, a significant reduction in late rectal and urinary toxicity has been observed.

Keywords: 3D-Image-guided-adaptive brachytherapy; Brachytherapy; Chemoradiotherapy; Gastrointestinal toxicity; Genitourinary toxicity; Late radiation toxicities; Locally advanced cervical cancer.

MeSH terms

Brachytherapy* / adverse effects
Brachytherapy* / methods
Female
Humans
Radiotherapy Dosage
Radiotherapy, Conformal* / adverse effects
Radiotherapy, Conformal* / methods
Radiotherapy, Intensity-Modulated* / methods
Rectum
Retrospective Studies
Treatment Outcome
Uterine Cervical Neoplasms* / pathology