S404
Clinical - Gynaecological
ESTRO 2026
4 Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 5 The Chair and Clinic of Oncology and Brachytherapy, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland. 6 Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland. 7 Department of Brachyterapy, Lower Silesian Oncology Pulmonology and Hematology Center, Wroclaw, Poland. 8 Clinical Department of Brachytherapy, Prof Franciszek Lukaszczyk Oncology Center in Bydgoszcz, Bydgoszcz, Poland. 9 IIIrd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland. 10 II Department of Gynecological Oncology, Saint John’s Cancer Center, Lublin, Poland. 11 Department of Radiation Oncology, Strasbourg Europe Cancer Institute (ICANS), Strasbourg, France. 12 Department of Radiation Oncology, Comprehensive Cancer Center, Medical University, General Hospital of Vienna, Vienna, Austria Purpose/Objective: Reirradiation (reRT) for recurrent gynecologic cancers other than endometrial carcinoma remains a therapeutic challenge due to cumulative dose constraints and high risk of pelvic toxicity. Advances in image-guided brachytherapy (IGBT) and modern external beam radiotherapy (EBRT) enable safe retreatment in carefully selected cases (1). This study aimed to assess long-term oncologic outcomes, toxicity, and prognostic factors in patients with recurrent non- endometrial gynecologic malignancies treated with definitive reRT. Material/Methods: From 2008 to 2024, 86 patients with recurrent non-endometrial gynecologic cancers were treated with reRT: vulvar (60.5%), ovarian (18.6%), cervical (17.4%), and vaginal (2.3%). Median age was 64 years (IQR
57–74); 55% had prior radical surgery, and 53% had local-only recurrence. Recurrence interval was 28.5 months (IQR 15–63). ReRT included BRT alone (55.8%), EBRT alone (20.9%), and combined EBRT + BRT (19.8%). Median total EQD ₂ was 43.4 Gy (IQR 29.7– 49.6). Concurrent chemotherapy was given to all patients. Survival and prognostic analyses were performed using Kaplan–Meier and Cox regression. Results: At a median follow-up of 45 months (IQR 28– 79), complete response (CR) was achieved in 87.8% of patients. Median overall survival (OS) = 75.1 months (95% CI 48.5–NA); 1-, 2-, 3- , and 5-year OS = 100%, 95.4%, 81.6%, and 62.0%. Median progression-free survival (PFS) = 26 months (95% CI 20–41) with corresponding rates 72.1%, 50.7%, 35.7%, and 23.9%. Local control (LC) at 1, 2, 3, and 5 years = 87.6%, 64.2%, 53.0%, and 39.9%. By tumor site, median OS for vulvar cancer was 68.2 months (48.7% mortality), while the cervical and ovarian groups were too small for median estimation. BRT alone yielded a CR rate of 95.8% and a median OS of 43 months, whereas EBRT + BRT achieved the longest OS (103 months). No statistically significant prognostic variables were confirmed. Acute ≥ G2 toxicity occurred in 2.3% (GU) and 4.7% (GI). Late ≥ G2 toxicity occurred in 17.4% (GU) and 12.8% (GI); G3 events in 14% (GU) and 7% (GI). Ten patients (11.8%) developed fistulas (median cumulative EQD ₂ 137.6 Gy), 80% managed conservatively; no G4–5 events were observed. Conclusion: Modern image-guided reirradiation provides durable disease control with acceptable toxicity in carefully selected patients with recurrent non-endometrial gynecologic cancers. Combined EBRT + BRT yields the most sustained outcomes and should be prioritized within a multidisciplinary treatment strategy, particularly for isolated pelvic or regional relapse. Prospective multicenter studies incorporating
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