Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study.
Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicators. The aim of this analysis was to evaluate the impact on local control and late morbidity of application of combined IS/IC brachytherapy in a large multicentre population.



610 patients with LACC from the retroEMBRACE study were included. Patients were divided into an IC group (N=310) and an IC/IS group (N=300). The IC/IS group was defined from the time point, when a centre performed IC/IS brachytherapy in more than 20% of cases.



With systematic usage of IC/IS the D90 of CTVHRincreased from 83±14Gy to 92±13Gy (p<0.01). No difference in doses to organs at risk was found. The 3-year local control rate in patients having a CTVHRvolume⩾30cm3was 10% higher (p=0.02) in the IC/IS group. No difference was found for CTVHR<30cm3(p=0.50). No significant difference in late morbidity was found between the IC/IS group and IC group.



Combined IC/IS brachytherapy improves the therapeutic ratio in LACC by enabling a tumour specific dose escalation resulting in significantly higher local control in large tumours without adding treatment related late morbidity.
Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: Larfok@rm.dk.
Lars
L
Fokdal
Department of Radiation Oncology, Medical University of Vienna, Austria.
Alina
A
Sturdza
Radiation Oncology Department, Gustave Roussy Cancer Campus Grand Paris, France.
Renaud
R
Mazeron
Radiation Oncology Department, Gustave Roussy Cancer Campus Grand Paris, France.
Christine
C
Haie-Meder
Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Trust, United Kingdom.
Li Tee
LT
Tan
Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland.
Charles
C
Gillham
Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
Barbara
B
Šegedin
Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands.
Ina
I
Jürgenliemk-Schultz
Department of Radiation Oncology, Medical University of Vienna, Austria.
Christian
C
Kirisits
Cancer Centre, Mount Vernon Hospital, London, United Kingdom.
Peter
P
Hoskin
Department of Radiation Oncology, Medical University of Vienna, Austria.
Richard
R
Pötter
Department of Oncology, Aarhus University Hospital, Denmark.
Jacob C
JC
Lindegaard
Department of Oncology, Aarhus University Hospital, Denmark.
Kari
K
Tanderup
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015642:Radiology, Interventional / Q000379:methods*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D055815:Young Adult
Cervical cancer; Image guided adaptive radiotherapy; Local control; Morbidity