title: Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy.
abstract: OBJECTIVE
  Since the Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC-ESTRO) published recommendations for 3D MRI-based image-guided adaptive brachytherapy (IGBT) in the treatment of cervical cancer, many institutions have implemented this technique and favourable results were documented. We investigated if introduction of IGBT in our centre indeed improved treatment outcomes and reduced toxicity compared to conventional brachytherapy (CBT).
  
  
  METHODS
  A retrospective analysis was done of outcomes of patients with stage IB-IVA cervical cancer treated with primary radiation therapy with curative intent between 2000 and 2012. Outcome measures were overall and disease-free survival, pelvic control, distant metastasis and treatment related adverse events (AE).
  
  
  RESULTS
  126 patients were analysed; 43 had been treated with CBT between 2000-2007, and 83 with IGBT between 2007-2012. External beam radiation (mean; 46.6Gy) was combined with concurrent weekly cisplatin (51.6%), or hyperthermia (24.6%); radiation alone was used in 23.8%. Median follow-up was 121.8months for CBT patients, vs. 42.3months for IGBT. Complete remission was achieved in 83.7% of patients in the CBT group and in 98.8% of IGBT patients (p<0.01). Overall survival at 3years was 51% and 86%, respectively (p=0.001). Pelvic recurrence was found in 32% vs. 7% (p<0.001). Most patients had low grade adverse events. High grade (3-4) AE occurred in 15.4% vs. 8.4% at 3years (p=0.06).
  
  
  CONCLUSIONS
  Introduction of IGBT for cervical cancer has led to significantly increased 3-year locoregional control and survival rates, whilst reducing late morbidity.
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: Rijkmans
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Nout
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: I H H M
authors.initials: IH
authors.lastname: Rutten
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ketelaars
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: Neelis
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M S
authors.initials: MS
authors.lastname: Laman
authors.affiliation: Zeeuws Radiotherapy Institute, Vlissingen, The Netherlands.
authors.forename: V L M A
authors.initials: VL
authors.lastname: Coen
authors.affiliation: Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: K N
authors.initials: KN
authors.lastname: Gaarenstroom
authors.affiliation: Department of Clinical Oncology, Subdivision of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: Kroep
authors.affiliation: Department of Clinical Oncology, Subdivision of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: c.l.creutzberg@lumc.nl.
authors.forename: C L
authors.initials: CL
authors.lastname: Creutzberg
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Cervical cancer; GEC–ESTRO guidelines; Image-guided brachytherapy; Primary chemoradiation; Radiotherapy; Survival