Cervical cancer treated whit HDR-brachytherapy MRI-based according to the recommendations GEC-ESTRO
Maria Francisca Ropero Carmona,
Spain
PO-1799
Abstract
Cervical cancer treated whit HDR-brachytherapy MRI-based according to the recommendations GEC-ESTRO
Authors: Maria Francisca Ropero Carmona1, Juan Quirós Rivero2, Julia Luisa Muñoz García2, Joaquín José Cabrera Rodríguez2, Yesica Ríos Kavadoy2, Victoria Vera Barragán2, Paula Simón Silva2, Beatriz Baños Pérez2, Carmen Corral Fernandez2, María Gonzalez de Dueñas2
1Complejo Hospitalario de Badajoz , Oncología Radioterápica, Badajoz, Spain; 2Complejo Hospitalario Universitario Badajoz, Oncología Radioterápica, Badajoz, Spain
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Purpose or Objective
To report our experience in patients with cervical cancer treated with External Beam Radiotherapy (EBRT) and High-Dose-Rate Intracavitary Brachytherapy (HDR-BT) MRI based IGABT (Image Guided Adaptive Brachytherapy).
The standard treatment for locally advanced cervical cancer is currently radio-chemotherapy consisting of EBRT plus concomitant chemotherapy with Cisplatin weekly and intracavitary BT.
GEC ESTRO recommends the use image-based brachytherapy and Retro-EMBRACE and EMBRACE, which will establish MRI-guided brachytherapy as a gold standard.
Material and Methods
From October 2015 to October 2020, 60 patients with cervical cancer stages I-IV underwent definitive treatment.
Patients were subjected to MRI-based-Brachytherapy post EBRT/concurrent chemotherapy using GEC-ESTRO guidelines.
Median age was 56 years. Histology was 73% squamous cell carcinoma and 27% adenocarcinoma. The most frequent clinical stage was IIB (54%). The median tumor size was 45 mm. Median dose EQD2 total (α/β=10) was 89Gy. Median dose HR-CVTD90 (α/β=10) 90Gy and IR-CVTD90 67Gy. The median dose of organs at risk (OAR) D2cc EQD2 (α/β=3): bladder 73Gy, rectum 64Gy and sigma 62Gy. The overall treatment time was ≥8 weeks in 98.2% of the patients with a median overall treatment time of 78 days. Toxicity was evaluated by CTCAE v4.0. Local Control (LC), Disease Free Survival. (DFS) and Overall Survival (OS) were estimated using the Kaplan-Meier method.
Results
With a median follow-up of 42 months (8-68), LC was 95%.
MRI-confirmed complete response was 82%.
The first relapse was Local recurrence 4%, Pelvic recurrence 2%, Local and regional recurrence 2% and distant metastasis 18%.
The 4-year LC, DFS and OS rates were 96%, 72.5% and 82%, respectively.
Prevalence rates of acute toxicity intestinal were G1 18%; rectal acute toxicity was 25% G1, 2% G3 (1 patient) and bladder acute toxicity was G1 11%. We have not observed G3 toxicity intestinal or bladder. Prevalence rates of chronic toxicity intestinal were G2 4%, bladder chronic toxicity G1 4%, G3 2% and rectal chronic toxicity G1 4% and G3 4% (2 patients).
Conclusion
HDR-BT MRI based IGABT allows doses >90Gy to HDR-CTV to be administered getting a good LC whit acceptable toxicity.
We need to improve the overall treatment time.