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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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4/2022
vol. 14
 
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abstract:
Original paper

Early clinical outcomes of hybrid brachytherapy for locally advanced cervical cancer: making adverse situations in a favorable scenario

Leonel Varela Cagetti
1
,
Christophe Zemmour
2
,
Eric Lambaudie
3
,
Magalie Provansal
4
,
Renaud Sabatier
4, 5
,
Laura Sabiani
6
,
Guillaume Blache
6
,
Camille Jauffret
6
,
Marjorie Ferré
7
,
Agnès Tallet
1
,
Laurence Gonzague
1

  1. Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
  2. Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
  3. Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
  4. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France,
  5. Département d’Oncologie Moléculaire, “Equipe labellisée Ligue Contre le Cancer”, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France,
  6. Institut Paoli Calmettes, Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
  7. Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
J Contemp Brachytherapy 2022; 14, 4: 321–331
DOI: https://doi.org/10.5114/jcb.2022.118831
Online publish date: 2022/08/17
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Introduction
To investigate the feasibility and early clinical outcomes of combined intra-cavitary (IC) and interstitial (IS) image-guided adaptive brachytherapy (IGABT) as curative and definitive treatment of patients treated with chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC).

Material and methods
Data from medical records of all consecutive patients with histologically proven cervical cancer (FIGO 2018 stage IB-IV), treated by brachytherapy after CCRT at our institution between 2017 and 2020 were reviewed.

Results
One hundred and forty-two patients with LACC FIGO 2018 stages (IB: 20.4%, II: 31.7%, III: 45.8%, IV: 2.1%) underwent brachytherapy at our institution, out of which 53.5% underwent combined brachytherapy technique (IC/IS). Median number of implanted catheters was 3 (range, 1-6 catheters). None of the 142 patients required invasive hemorrhage management. With a median follow-up of 21.6 (95% CI [confidence interval]: 19.1-23.5%) months, local relapse was observed in nine patients (6.3%), with four showing persistent and progressive disease. The estimated 2-year local and pelvic relapse-free survival were 92% (95% CI: 84-96%) and 90% (95% CI: 83-94%), respectively. The estimated 2-year disease-free survival for the entire population was 80% (95% CI: 71-87%). The 2-year overall survival (OS) rate for the entire population was 92% (95% CI: 84-96%). Acute toxicity G3 was reported in two (1.4%) patients. High-grade late toxicity (grade 3) was reported in 9 (6.3%) patients.

Conclusions
Combined IC/IS brachytherapy for LACC allows for recommended doses to achieve local control even in large tumors after CCRT improving target volume coverage, with low rates of acute morbidity. Hybrid brachytherapy technique (IC/IS) is essential to have a favorable scenario at the time of brachytherapy to correctly treat locally advanced cervical cancer patients.

keywords:

locally advanced cervical cancer, image-guided adaptive brachytherapy, interstitial brachytherapy, local control, vaginal morbidity

  
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