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Outcome analysis of HDR compared to PDR IGABT in locally advanced cervical cancer: a single-center cohort analysis

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Abstract

Purpose

This monocentric study aimed to assess the impact of technical advancement in brachytherapy (BT) on local control (LC) and cancer-specific survival (CSS) in locally advanced cervical cancer (LACC).

Methods

Since 2010, 211 patients with LACC have been treated with 45/50.4 Gy or 60 Gy radiochemotherapy (RTCT) followed by image-guided adaptive brachytherapy (IGABT) at the authors’ institution. In 2013, combined intracavitary and interstitial brachytherapy (BT IC/IS) was implemented and in 2018, pulsed-dose-rate BT (PDR-BT) was replaced by high-dose-rate BT (HDR-BT). LC, CSS, and morbidity according to the RTOG/EORTC scoring system were analyzed. Dose–volume parameters for the high-risk clinical target volume (HRCTV) and organs at risk (OAR) were reported.

Results

While 27 (12.8%) patients died of LACC, complete local remission was achieved in 199 (94.3%). Local relapse decreases with a high D95 in the HRCTV (hazard ratio, HR = 0.85, p = 0.0024). D95 in the HRCTV is lower after 60 Gy even if interstitial BT is used. Mean D95 in the HRCTV is 78.2 Gy, 83.3 Gy, and 83.4 Gy with PDR-BT IC, PDR-BT IC/IS, and HDR-BT IC/IS, respectively, after 45/50.4 Gy. D2 cc of OARs is significantly reduced by using interstitial BT. The mean rectum and sigmoid D2 cc are about 61.5 Gy with PDR-BT IC/IS and significantly decreased with HDR-BT IC/IS. This translates into a low fistula incidence. A very low rate of severe gastrointestinal (3.4%) and genitourinary (2.3%) toxicity was observed with HDR-BT IC/IS.

Conclusion

This large monocentric study provides further evidence that implementation of BT IC/IS has an impact on D95 in the HRCTV, LC, and CSS. There are no differences between HDR and PDR in terms of efficacy, D95 in the HRCTV, and toxicity grade ≥ 3.

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Authors and Affiliations

  1. Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium

    Johanne Hermesse M.D., Christine Gennigens Ph.D. & Philippe Coucke Ph.D.

  2. Department of Radiotherapy Oncology, Centre François Baclesse, Esch sur Alzette, Luxembourg

    Johanne Hermesse M.D.

  3. Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium

    Clémence Pleyers M.D.

  4. Department of Gynecology, University Hospital of Liège, Liège, Belgium

    Marjolein De Cuypere Ph.D. & Frédéric Kridelka Ph.D.

  5. Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium

    Pierre Lovinfosse Ph.D.

  6. Department of Biostatistics, University Hospital of Liège, Liège, Belgium

    Laurence Seidel Statistician

  7. CHU Sart Tilman, Avenue de l’hôpital 1, 4000, Liège, Belgium

    Johanne Hermesse M.D.

  8. Centre François Baclesse, 51 Rue Emile Mayrisch, 4240, Esch sur Alzette, Luxembourg

    Johanne Hermesse M.D.

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  1. Johanne Hermesse M.D.
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  2. Clémence Pleyers M.D.
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  3. Christine Gennigens Ph.D.
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  4. Marjolein De Cuypere Ph.D.
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  5. Pierre Lovinfosse Ph.D.
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  6. Laurence Seidel Statistician
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  7. Philippe Coucke Ph.D.
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  8. Frédéric Kridelka Ph.D.
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Correspondence to Johanne Hermesse M.D..

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Conflict of interest

J. Hermesse, C. Pleyers, C. Gennigens, M. De Cuypere, P. Lovinfosse, L. Seidel Statistician, P. Coucke, and F. Kridelka declare that they have no competing interests.

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Hermesse, J., Pleyers, C., Gennigens, C. et al. Outcome analysis of HDR compared to PDR IGABT in locally advanced cervical cancer: a single-center cohort analysis. Strahlenther Onkol 199, 141–148 (2023). https://doi.org/10.1007/s00066-022-01982-7

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  • DOI: https://doi.org/10.1007/s00066-022-01982-7

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