title: Clinical outcomes of definitive chemoradiation followed by intracavitary pulsed-dose rate image-guided adaptive brachytherapy in locally advanced cervical cancer.
abstract: OBJECTIVE
  To report the outcomes and late toxicities of patients with locally advanced cervical cancer treated with concomitant chemoradiation (CRT) followed by intracavitary image-guided adaptive brachytherapy (IGABT).
  
  
  METHODS
  Data from consecutive patients with histologically proven stage IB-IVA cervical cancer treated with curative intent in a single institution were analyzed. After pelvic +/- para-aortic external-beam radiation therapy, they received pulsed-dose rate IGABT following GEC-ESTRO recommendations.
  
  
  RESULTS
  Two hundred and twenty-five patients were enrolled. Sixty-five percent were stage≥IIB according to FIGO classification. Ninety-five percent received CRT. Mean D90 to HR and IR-CTV were 80.4+/-10.3Gy and 67.7+/-6.1Gy. After a median follow-up of 38.8months, 3-year local control and overall survival rates were 86.4% and 76.1%, respectively. A trend for a detrimental effect of tumor stage on local control rates was observed with 3-year local control rates of 100% for stages IB1 and IIA, 90.5 for IB2, 85.8% for IIB, 50% for IIIA, 77.1 for IIIB, and 66.7% for IVA tumors (p=0.06). Local control rates at 3years were 95.6% in the group of patients with D90 of HR-CTV≥85Gy, 88.8% in those with D90 between 80 and 85Gy, and 80% when D90<80Gy (p=0.018). Eighteen severe late gastrointestinal and urinary effects affecting 14 patients were reported corresponding with a crude incidence of 6.6%.
  
  
  CONCLUSIONS
  CRT followed by IGABT provides high local control rates with limited toxicity. Reaching high doses is mandatory to achieve local control and interstitial brachytherapy is necessary in advanced diseases.
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Castelnau-Marchand
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France; Molecular Radiotherapy INSERM 1030, Gustave Roussy Cancer campus, 94805 Villejuif Cedex, France.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Maroun
authors.affiliation: Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France.
authors.forename: Eleonor Rivin
authors.initials: ER
authors.lastname: Del Campo
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France.
authors.forename: Kim
authors.initials: K
authors.lastname: Cao
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Petit
authors.affiliation: Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Martinetti
authors.affiliation: Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Tafo-Guemnie
authors.affiliation: Molecular Radiotherapy INSERM 1030, Gustave Roussy Cancer campus, 94805 Villejuif Cedex, France; Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Lefkopoulos
authors.affiliation: Gynecological Surgery, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.affiliation: Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France; Molecular Radiotherapy INSERM 1030, Gustave Roussy Cancer campus, 94805 Villejuif Cedex, France. Electronic address: renaud.mazeron@gustaveroussy.fr.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001918:Brachytherapy; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D061089:Radiotherapy, Image-Guided; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: D90; Image-guided adaptive brachytherapy; Local control; Locally advanced cervical cancer; Morbidity