S403
Clinical - Gynaecological
ESTRO 2026
Cancer Center, Guangzhou, China. 13 Radiotherapy center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. 14 Gynecologic Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China Purpose/Objective: Radiation-induced rectal injury was a major issue in cervical cancer patients who received concurrent chemoradiotherapy (CCRT), with over 70% developing radiation-induced acute rectal injury (RARI), and 5-20% developing radiation-induced late rectal injury (RLRI). This study aimed to evaluate the efficacy of rhSOD enema through endoscopy in preventing radiation-induced rectal injury for patients with locally advanced cervical cancer (LACC). Material/Methods: This was a phase III, multicenter, randomized, open-label trial (NCT04819685) in China. All patients received CCRT and were randomized to the experimental and control groups at a ratio of 1:1 after endoscopy at baseline. The experimental group was treated with rhSOD enema during CCRT, and the control group received no placebo enema. A colorectoscope was performed at baseline and within 3 months after completing CCRT. The endoscopy appearance was assessed according to the Vienna Rectoscopy Score (VRS) and was compared using the Mann- Whitney U test. Results: Five hundred and sixteen patients were enrolled and randomized to the experimental (n = 260) and control group (n = 256) after finishing the colorectoscope at baseline. Baseline clinical (age, BMI, FIGO stage), radiotherapy plans, and Chemotherapy regimen were balanced (all P > 0.05). The median follow-up time was 26.2 months. The mean Rectum D2cc was 68.8 Gy in the experimental group and 68.3 Gy in the control group. Regarding the D2cc of the
other OARs, no statistically signi fi cant differences were found between the 2 groups. There were no differences in the pre- treatment VRS scores of endoscopy between the two groups (P = 0.51). Two hundred and eighteen patients in the experimental group and two hundred one patients in the control group finished the post-treatment colorectoscope (completion rate 81%, P = 0.24). The post-treatment endoscopy showed that the VRS scores of RARI in the experimental group were lower than those in the control group (Grade N: 80.2% vs. 66.3%, Grade 0: 15.2% vs. 25.2%, Grade 1: 3.2% vs. 5.9%, Grade 2: 0.9% vs. 1.5%, P = 0.001). In ordered logistic regression, rhSOD enema was the only factor associated with lower VRS scores (P = 0.002). In terms of RLRI, 6.7% of patients in the experimental group had a VRS score ≥ 3 injury, significantly lower than the 11.5% in the control group (P = 0.023). Conclusion: Using rhSOD enema in LACC patients who underwent CCRT could protect the rectal mucosa from acute injury and may lower the risk of RLRI. Keywords: cervical cancer, radiation-induced rectal injury Image-Guided Reirradiation for Recurrent Non-Endometrial Gynecologic Cancers: A Multi-Institutional Real-World Analysis Mateusz Bilski 1,2 , Federico Mastroleo 3 , Agnieszka Zolciak-Siwinska 4 , Marta Biedka- Paluch 5 , Martin Rydzinski 4 , Magdalena Stankiewicz 6 , Katarzyna Konat 7 , Janusz Winiecki 8 , Iga Racka 8 , Monika Szoltysik 9 , Monika Bilska 10 , Paulina Porwol 8 , Noel Georges 11 , Alina Sturdza 12 1 Radiotherapy Department, Affidea Nu-med Center of Oncological Diagnostics and Therapy, Zamosc, Poland. 2 Clinics of Radiotherapy, Medical University of Lublin, Lublin, Poland. 3 Department of Radiation Oncology, Mayo Clinic, Rochester, USA. Poster Discussion 664
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