ESTRO 2022

Session Item

Monday

May 09

14:15 - 15:15

Poster Station 2

22: Gynaecological

Chair: , Italy

Session Type: Poster Discussion

Track: Clinical

Journey:

Early outcomes of abbreviated brachytherapy schedule for cervix cancer during COVID pandemic.

Supriya Chopra, India

Presentation Number: PD-0910

Abstract

Abstract Title:

Early outcomes of abbreviated brachytherapy schedule for cervix cancer during COVID pandemic.

Authors:

Supriya Chopra¹, Jaahid Mulani¹, Maneesh Singh², Amruta Shinde³, Prachi Mittal³, Lavanya Gurram³, Libin Scaria⁴, Dheera A⁵, Satish Kohle⁵, Priyanka Rane⁵, Yogesh Ghadi⁵, Sushmita Rath⁶, Jaya Ghosh⁷, Seema Gulia⁶, Sudeep Gupta⁷, Rajesh Kinhikar⁵, Sarbani Laskar³, Jai Prakash Agarwal³

¹ Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Radiation Oncology, Navi Mumbai, India; ²Tata memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Radiation Oncology, Mumbai, India; ³Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Radiation Oncology, Mumbai, India; ⁴Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Medical Physics , Mumbai, India; ⁵Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Medical Physics, Mumbai, India; ⁶Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Medical Oncology, Mumbai, India; ⁷Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Medical Oncology, Navi Mumbai, India

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Purpose or Objective

COVID-19 pandemic led to restructuring of cancer care. In India, a nationwide complete lockdown was announced in March, 2020 which was released in a phased manner. Cervical cancer brachytherapy (BT) was listed as level 1 priority across consensus guidelines that also recommended reduced insertions. We present early outcomes of abbreviated schedule.

Material and Methods

Patients treated with (chemo) radiotherapy and BT from April 2020 to March 2021 and who received single insertion and multiple fractions (3-5) BT over a 24-48 hrs either due to infrastructural resource constraints or excessive prolongation of overall treatment time (OTT) were included. Those with central/medial parametrial disease at BT received intracavitary(IC) and those with poor response or unfavourable organ at risk doses received Intracavitary-interstitial (IC+IS) application. IBS-GEC ESTRO-ABS guidelines were used for high risk clinical target volume (HRCTV) delineation. Treatment protocol included single implant and 3-5 BT fractions of BT 5-8.5 Gy with an aim to achieve point A dose of 70 Gy EQD2_10Gy or HRCTV dose> 85 Gy EQD2_10Gy while maintaining bladder (B2cc), rectum (R2cc), sigmoid (S 2cc) doses of 90 ,75 and 75 Gy EQD2_3Gy.Time to event analysis was used to report oncological endpoints. Toxicity was reported using crude proportions.

Results

Three hundred and sixteen patients received radical treatment. Sixty four patients (20%) received abbreviated BT schedule. While 29.7% (19) patients had FIGO stage IB2-IIB, 70.3 %(45) had stage III-IV. Due to the pandemic only 77% (n=49) patients received concurrent chemotherapy with 82% (n=40) receiving ≥ 4cycles. Seven patients (11%) acquired COVID-19 infection. Median OTT was 56 days (38-131 days). Prolongation was either due to COVID infection (7.8%) or delay in referral for BT(42%).

Overall 62.5% (n=40) patients received IC application and 37.5% (n=24) received IC+IS. The median HRCTV for IC application was 33 cc (IQR 25-44). Median point A dose, HRCTV D90, B2cc,R2cc and S2cc was 74 Gy (71-78), 80Gy (73-84),86 Gy (82-89),70 Gy(65-74), 65 Gy (59-73) respectively. For those with IC+IS application the median HRCTV was 35 cc(27-45cc).The HRCTV D90, B2cc, R2cc and S2cc was 84 Gy (78-89 Gy), 89 Gy (86-92), 70 Gy (67-74),68 Gy (59-76).

At a median follow-up of 12 (5 to 18 ) months, there were 6 pelvic relapses, 10 pelvic or distant events and 5 deaths (2 due to COVID or cardiac related mortality and 1 due to bowel late toxicity, 2 due to disease progression). The 12 month local control, disease free and overall survival was 90.6%, 82.8%, 92.2%. Three patients developed Grade III-IV rectal toxicity (4.6%) and 1 patient (1.6%) developed grade III bladder toxicity.

Conclusion

The 12-month oncological outcomes with abbreviated BT are comparable to previously published outcomes for cervix cancer. However, careful evolution of adverse events needs to be observed before routine recommendation of this as an alternative treatment option.