title: Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study.
abstract: Image guided brachytherapy (IGBT) for locally advanced cervical cancer allows dose escalation to the high-risk clinical target volume (HRCTV) while sparing organs at risk (OAR). This is the first comprehensive report on clinical outcome in a large multi-institutional cohort.
  
  
  
  From twelve centres 731 patients, treated with definitive EBRT±concurrent chemotherapy followed by IGBT, were analysed. Kaplan-Meier estimates at 3/5years were calculated for local control (LC, primary endpoint), pelvic control (PC), overall survival (OS), cancer specific survival (CSS). In 610 patients, G3-4 late toxicity (CTCAEv3.0) was reported.
  
  
  
  Median follow up was 43months, percent of patients per FIGO stage IA/IB/IIA 22.8%, IIB 50.4%, IIIA-IVB 26.8%. 84.8% had squamous cell carcinomas; 40.5% lymph node involvement. Mean EBRT dose was 46±2.5Gy; 77.4% received concurrent chemotherapy. Mean D90 HRCTV was 87±15Gy (EQD210), mean D2cc was: bladder 81±22Gy, rectum 64±9Gy, sigmoid 66±10Gy and bowel 64±9Gy (all EQD23). The 3/5-year actuarial LC, PC, CSS, OS were 91%/89%, 87%/84%, 79%/73%, 74%/65%. Actuarial LC at 3/5years for IB, IIB, IIIB was 98%/98%, 93%/91%, 79%/75%. Actuarial PC at 3/5years for IB, IIB, IIIB was 96%/96%, 89%/87%, 73%/67%. Actuarial 5-year G3-G5 morbidity was 5%, 7%, 5% for bladder, gastrointestinal tract, vagina.
  
  
  
  IGBT combined with radio-chemotherapy leads to excellent LC (91%), PC (87%), OS (74%), CSS (79%) with limited severe morbidity.
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
authors.forename: Alina
authors.initials: A
authors.lastname: Sturdza
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria. Electronic address: richard.poetter@meduniwien.ac.at.
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.affiliation: Aarhus University Hospital, Department of Oncology, Denmark.
authors.forename: Lars Ulrik
authors.initials: LU
authors.lastname: Fokdal
authors.affiliation: Gustave Roussy Cancer Campus Grand Paris, Department of Radiation Oncology, Villejuif, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.affiliation: Cambridge University Addenbrooke's Hospital, Department of Radiotherapy, United Kingdom.
authors.forename: Li Tee
authors.initials: LT
authors.lastname: Tan
authors.affiliation: Gustave Roussy Cancer Campus Grand Paris, Department of Radiation Oncology, Villejuif, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Institute of Oncology Ljubljana, Division of Radiotherapy, Slovenia.
authors.forename: Primoz
authors.initials: P
authors.lastname: Petric
authors.affiliation: Institute of Oncology Ljubljana, Division of Radiotherapy, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Šegedin
authors.affiliation: University Medical Center Utrecht, Department of Radiotherapy, The Netherlands.
authors.forename: Ina Maria
authors.initials: IM
authors.lastname: Jurgenliemk-Schulz
authors.affiliation: University Medical Center Utrecht, Department of Radiotherapy, The Netherlands.
authors.forename: Christel
authors.initials: C
authors.lastname: Nomden
authors.affiliation: St Luke's Hospital, Dublin, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: Gillham
authors.affiliation: St Luke's Hospital, Dublin, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: McArdle
authors.affiliation: Department of Radiotherapy, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Van Limbergen
authors.affiliation: Department of Radiotherapy, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: Janssen
authors.affiliation: Mount Vernon Hospital, Department of Radiotherapy, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoskin
authors.affiliation: Mount Vernon Hospital, Department of Radiotherapy, London, United Kingdom.
authors.forename: Gerry
authors.initials: G
authors.lastname: Lowe
authors.affiliation: Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: Ekkasit
authors.initials: E
authors.lastname: Tharavichitkul
authors.affiliation: University of Navarra, Department of Oncology, Pamplona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Villafranca
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Mahantshetty
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Georg
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kirchheiner
authors.affiliation: Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Kirisits
authors.affiliation: Aarhus University Hospital, Department of Oncology, Denmark.
authors.forename: Kari
authors.initials: K
authors.lastname: Tanderup
authors.affiliation: Aarhus University Hospital, Department of Oncology, Denmark.
authors.forename: Jacob Christian
authors.initials: JC
authors.lastname: Lindegaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D058958:Organs at Risk; D010388:Pelvis; D015642:Radiology, Interventional / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D055815:Young Adult
keywords: Image guided brachytherapy; Locally advanced cervical cancer; Outcome