Clinical outcome of combined intracavitary / interstitial brachytherapy using a hybrid applicator in locally advanced cervical cancer

Gynecol Oncol. 2022 Sep;166(3):576-581. doi: 10.1016/j.ygyno.2022.06.019. Epub 2022 Jun 25.

Abstract

Objective: The aim of this study was to evaluate the clinical outcome in locally advanced cervical cancer (LACC) after image-guided adaptive brachytherapy (IGABT) with combined intracavitary and interstitial (IC/IS) techniques using the hybrid Venezia applicator (Elekta AB, Sweden).

Methods: LACC patients (UICC Stage IIB - IVB) treated with radiochemotherapy followed by IGABT with the hybrid IC/IS Venezia applicator at a single institution were retrospectively analyzed. Treatment comprised EBRT of the pelvis with 45 Gy and concomitant weekly cisplatin chemotherapy (40 mg/m2) followed by MRI-based IGABT. Dosimetry, oncological outcome and toxicity were investigated.

Results: Forty-six patients underwent a total of 184 fractions of IGABT between 2017 and 2020. Median follow-up was 24 months. Combined IC/IS techniques were used in 40 patients (87%). The median HRCTV volume was 31.2 cm3 and the median HRCTV D90% was 92.3 Gy (EQD210). The median D2cm3 was 74.8 Gy for bladder, 57.9 Gy for rectum, 60.0 Gy for sigmoid and 52.2 Gy for bowel (EQD23). The 3-yr actuarial rates were 97.6% for local control, 97.6% for pelvic control, 59.9% for distant metastasis-free survival and 81.6% for overall survival. The crude rate for G2 and G3 late toxicity was 21.7% and 4.3%.

Conclusions: IGABT with the hybrid Venezia applicator and a pronounced use of a combined IC/IS technique achieved high target doses, while maintaining low doses to organs at risk, leading to excellent local control and overall survival rates with acceptable toxicity.

Keywords: Brachytherapy; Cervical cancer; IGABT; Interstitial; Venezia.

MeSH terms

  • Brachytherapy* / adverse effects
  • Brachytherapy* / methods
  • Female
  • Humans
  • Organs at Risk
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / methods
  • Retrospective Studies
  • Treatment Outcome
  • Uterine Cervical Neoplasms* / drug therapy
  • Uterine Cervical Neoplasms* / radiotherapy