title: Assessment of Parametrial Response by Growth Pattern in Patients With International Federation of Gynecology and Obstetrics Stage IIB and IIIB Cervical Cancer: Analysis of Patients From a Prospective, Multicenter Trial (EMBRACE).
abstract: OBJECTIVE
  To assess disease response along the parametrial space according to tumor morphology in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB and IIIB cervical cancer at the time of image-guided adaptive brachytherapy.
  
  
  METHODS
  Patients with FIGO stage IIB and IIIB cervical cancer registered as of November 2013 in the EMBRACE study were evaluated. Tumors were stratified according to morphologic subtype on magnetic resonance imaging (expansive and infiltrative), and the characteristics of those subtypes were analyzed. Parametrial involvement at diagnosis and at brachytherapy was evaluated, and the response to chemo-radiotherapy was classified as good, moderate, or poor. The response grade was compared between the 2 groups and analyzed with regard to tumor volumes, and dosimetric parameters.
  
  
  RESULTS
  A total of 452 patients were evaluated, of whom 186 had expansive growth type and 266 had infiltrative morphology. Patients with infiltrative tumors had more extensive disease, as indicated by a higher rate of FIGO stage IIIB disease, as well as radiologic evidence of extension into the distal parametrial space and to the pelvic side wall on magnetic resonance imaging. Cervical necrosis was more common in the infiltrative group. Good response was more common in the expansive group (34% vs 24%; P=.02), and poor response was more common in the infiltrative group (11% and 19%; P=.02). Mean gross tumor volume at diagnosis was equal in both groups (51.7 cm(3)). The high-risk clinical target volume was larger in infiltrative tumors (37.9 cm(3) vs 33.3 cm(3), P=.005). The mean high-risk clinical target volume D90 was slightly higher in expansive tumors (92.7 Gy and 89.4 Gy, P<.001).
  
  
  CONCLUSIONS
  Infiltrative tumors are more advanced at presentation and respond less favorably to chemo-radiotherapy when compared with expansive tumors that are more or less equivalent in size. The use of image-guided adaptive brachytherapy allows achieving reasonably high doses in both groups.
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria; Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria; King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Noha
authors.initials: N
authors.lastname: Jastaniyah
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria. Electronic address: alina.sturdza@akhwien.at.
authors.forename: Alina
authors.initials: A
authors.lastname: Sturdza
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lindegaard
authors.affiliation: Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Segedin
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Mahantshetty
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Bhavana
authors.initials: B
authors.lastname: Rai
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Ina
authors.initials: I
authors.lastname: Jürgenliemk-Schulz
authors.affiliation: Institut Gustave Roussy, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.affiliation: Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Sasaki
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002584:Cervix Uteri / Q000473:pathology; D059248:Chemoradiotherapy / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D006176:Gynecology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000592:standards*; D009774:Obstetrics; D011446:Prospective Studies; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012075:Remission, Spontaneous; D012955:Societies, Medical; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*