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Single-institution experience in 3D MRI-based brachytherapy for cervical cancer for 239 women: can dose overcome poor response?
International Journal of Radiation Oncology, Biology, Physics 2018 December 32
INTRODUCTION: Recent GEC-ESTRO guidelines recommend that the dose to 90% (D90) of the high-risk clinical target volume (HRCTV) in cervical cancer be at least 85Gy with higher doses for poor response to radiotherapy.
METHODS AND MATERIALS: A retrospective review of brachytherapy delivered at a single institution were evaluated for dosimetry and outcomes. Significance of tumor parameters on local control was evaluated with Kaplan-Meier and uni- and multivariable Cox regression analysis. Correlations were determined with a linear regression model.
RESULTS: A total of 239 women underwent high dose-rate brachytherapy for cervical cancer between 2007 and 2018 with evaluable dosimetry. Median follow up was 28.6 months. The median prescribed dose was 27.5Gy/5fx with a median HRCTV D90 of 83.9Gy (range: 81.9-85.7 Gy), HRCTV volume of 31cc (range: 14.9-121.9cc), and treatment time of 51 days (range: 36-83). Local control for the entire cohort at 5 years was 90.8%. Local control was worse with adenocarcinomas (AC), HRCTV >40cc at brachytherapy, requiring a higher BT dose, and with treatment >51 days. On multivariable analysis local control was worse with AC (HR 4.141 [95%CI 1.498-11.444], p=0.006) and HRCTV >40cc (HR 3.640 [95%CI 1.316-10.069], p=0.013). HRCTV EQD2 D90 > 85Gy did not statistically improve outcomes for any subset. The 2-year PFS for HRCTV > 40cc was 66.2% vs 84.1% if ≤40cc (p<0.001). Overall survival (OS) was predicted by HRCTV and overall treatment time in multivariable analysis. For women with HRCTV ≤40cc OS at 2 years was 90.4% vs 68.5% if >40cc, (p<0.001).
CONCLUSION: Local control is excellent with MRI-based planning in the entire cohort of patients. A poor response to external beam radiation (larger HRCTV) and adenocarcinoma histology predicted for worse local control despite association with higher brachytherapy prescription. Women with these risk factors face higher rates of extra-pelvic progression and poorer overall survival.
METHODS AND MATERIALS: A retrospective review of brachytherapy delivered at a single institution were evaluated for dosimetry and outcomes. Significance of tumor parameters on local control was evaluated with Kaplan-Meier and uni- and multivariable Cox regression analysis. Correlations were determined with a linear regression model.
RESULTS: A total of 239 women underwent high dose-rate brachytherapy for cervical cancer between 2007 and 2018 with evaluable dosimetry. Median follow up was 28.6 months. The median prescribed dose was 27.5Gy/5fx with a median HRCTV D90 of 83.9Gy (range: 81.9-85.7 Gy), HRCTV volume of 31cc (range: 14.9-121.9cc), and treatment time of 51 days (range: 36-83). Local control for the entire cohort at 5 years was 90.8%. Local control was worse with adenocarcinomas (AC), HRCTV >40cc at brachytherapy, requiring a higher BT dose, and with treatment >51 days. On multivariable analysis local control was worse with AC (HR 4.141 [95%CI 1.498-11.444], p=0.006) and HRCTV >40cc (HR 3.640 [95%CI 1.316-10.069], p=0.013). HRCTV EQD2 D90 > 85Gy did not statistically improve outcomes for any subset. The 2-year PFS for HRCTV > 40cc was 66.2% vs 84.1% if ≤40cc (p<0.001). Overall survival (OS) was predicted by HRCTV and overall treatment time in multivariable analysis. For women with HRCTV ≤40cc OS at 2 years was 90.4% vs 68.5% if >40cc, (p<0.001).
CONCLUSION: Local control is excellent with MRI-based planning in the entire cohort of patients. A poor response to external beam radiation (larger HRCTV) and adenocarcinoma histology predicted for worse local control despite association with higher brachytherapy prescription. Women with these risk factors face higher rates of extra-pelvic progression and poorer overall survival.
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