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| Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2016 Apr 29. pii: S0167-8140(16)31018-0. doi: 10.1016/j.radonc.2016.03.011 |
| Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. |
| Sturdza A1, Pötter R2, Fokdal LU3, Haie-Meder C4, Tan LT5, Mazeron R6, Petric P7, Šegedin B8, Jurgenliemk-Schulz IM9, Nomden C10, Gillham C11, McArdle O12, Van Limbergen E13, Janssen H14, Hoskin P15, Lowe G16, Tharavichitkul E17, Villafranca E18, Mahantshetty U19, Georg P20, Kirchheiner K21, Kirisits C22, Tanderup K23, Lindegaard JC24 |
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Abstract PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: IGBT combined with radio-chemotherapy leads to excellent LC (91%), PC (87%), OS (74%), CSS (79%) with limited severe morbidity. |
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Copyright © 2016. Published by Elsevier Ireland Ltd. |
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KEYWORDS: Image guided brachytherapy, Locally advanced cervical cancer, Outcome |
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Publikations ID: 27134181 Quelle: öffnen |
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