title: Clinical efficacy and toxicity of radio-chemotherapy and magnetic resonance imaging-guided brachytherapy for locally advanced cervical cancer patients: A mono-institutional experience.
abstract: BACKGROUND
  To evaluate efficacy and toxicity of radio-chemotherapy (RCT) and MR-guided pulsed-dose-rate (PDR) adaptive brachytherapy (IGABT) for locally advanced cervical cancer (LACC).
  
  
  METHODS
  Between 2007 and 2014 85 patients with FIGO stage 1B1 N+ or ≥ 1B2 cervical cancer were treated with RCT+ IGABT. The treatment consisted of a pelvic± paraaortic external beam radiotherapy (EBRT) (45-50.4 Gy ± 10 Gy boost to primary tumor and/or to pathologic lymph nodes) with concurrent cisplatin followed by 25-35 Gy of PDR IGABT in 30-50 pulses. The ratio of 3D-CFRT/IMRT was 61/24 patients. Dose-volume parameters of high-risk clinical target volume (HR-CTV), intermediate-risk clinical target volume (IR-CTV) and D2cm(3) organs at risk (OARs) were reported. Local control (LC), cancer-specific survival (CCS) and overall survival (OS) were analyzed actuarially and morbidity crude rates were scored using CTCAEv4.0.
  
  
  RESULTS
  Mean follow-up was 36 months (range 6-94). The mean D90 and D98 for HR-CTV was 84.4 ± 9 Gy and 77 ± 8.1 Gy, while for IR-CTV was 69.1 ± 4.3 Gy and 64.8 ± 4.3 Gy, respectively. The mean D2cm(3) for OARs was the following: bladder: 77.3 ± 10.5 Gy, rectum: 65 ± 6.8 Gy, sigmoid: 63 ± 7.9 Gy and intestine: 64.0 ± 9.1 Gy. Three year LC, CSS and OS were: 94%, 85% and 81%. The three-year regional- and distant control rates were 95% and 74%. Node negative patients had significantly higher three-year CSS (100 vs. 72%, p = 0.016) and OS (92 vs. 72%, p = 0.001) compared to node positive ones. Three-year actuarial late Grade ≥ 3 morbidity was the following: GI: 8%, GU: 5%, Vaginal: 8%. The frequency of Grade ≥ 3 hematological toxicities including anemia/leukopenia/neutropenia/thrombocytopenia were 8.6%/34.7%/24.3%/24.3%, respectively.
  
  
  CONCLUSIONS
  This large mono-institutional experience builds up further evidences that IGABT in conjunction with RCT should be the standard of care for patients suffering LACC.
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Lakosi
authors.affiliation: b Department of Gynecology , University Hospital of Liège , Liège , Belgium.
authors.forename: Marjoelin
authors.initials: M
authors.lastname: de Cuypere
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Viet Nguyen
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jansen
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Warlimont
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Akos
authors.initials: A
authors.lastname: Gulyban
authors.affiliation: c Department of Clinical Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Gennigens
authors.affiliation: d Department of Biostatistics , University Hospital of Liège , Liège , Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Seidel
authors.affiliation: e Department of Pathology , University Hospital of Liège , Liège , Belgium.
authors.forename: Katty
authors.initials: K
authors.lastname: Delbecque
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Coucke
authors.affiliation: a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium.
authors.forename: Johanne
authors.initials: J
authors.lastname: Hermesse
authors.affiliation: b Department of Gynecology , University Hospital of Liège , Liège , Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: Kridelka
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D012809:Colon, Sigmoid; D019583:Dose Fractionation, Radiation; D005260:Female; D006402:Hematologic Diseases / Q000209:etiology; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012007:Rectum; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D001743:Urinary Bladder; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin