S442
Clinical - Gynaecological
ESTRO 2026
metastatic relapses (21.7%). Two year-overall survival (OS), locoregional relapse-free survival (LRRFS), metastasis-free survival (MFS) and event-free survival (EFS) were 84.9%, 88.1%, 74.7% and 69.3%, respectively. Treatment tolerance was excellent with only grade 1 acute (9.6%) and late toxicities (10.9%).
Purpose/Objective: Concomitant chemo-radiotherapy (CCR) with intensity modulated radiotherapy (IMRT), followed by high-dose-rate (HDR) brachytherapy (BT) is the treatment of choice for locally advanced cervical cancer (LACC). The aims of this study were to study therapeutic results, toxicity, prognostic factors and the impact of dose escalation and interstitial BT. Material/Methods: This study included patients treated with CCR (Median dose: 50.4 Gy [45-64]) and HDR BT (2-4 fractions of 7 Gy) between September 2021 and March 2025. Before January 2024, 2-3 fractions of HDR BT were delivered. Since January 2024, the EMBRACE II protocol [1] was adopted in our institution, and we started interstitial BT applications when indicated. Results: Ninety-two patients were included. Tumors were classified as stages IIB-IVA in 81 cases (88%). Sixteen patients received induction chemotherapy (17.4%). Nodal-boost was delivered to 32 patients (34.8%). Thirty-two patients received 4 fractions of BT (34.8%). Seventeen patients received intra-cavitary and interstitial BT (18.5%). Median treatment duration was 74 days [43-171]. Median D90% to high-risk CTV was 80.43 Gy [64.65-96.5]. Median D90% to intermediate risk CTV was 64.75 Gy [55.58-72.3]. First evaluation showed a complete response in 63 cases (68.5%). Twenty-five patients (27.2%) underwent closing surgery, and 15 histologic complete responses (60%) were found.In patients receiving more than 85 Gy to D90% of high-risk CTV, we noted more complete responses (92.3% versus 59.1%), and less surgery was performed (7.7% versus 34.8%). Similarly, in patients receiving interstitial BT, more complete responses were noted (82.4% versus 65.3%), and less surgery was performed (5.9% versus 32%).After a median follow-up of 24 months [6-50], there were 12 loco-regional relapses (13%) and 20
Stage IIB-IV was associated with worse OS (p=0.049), EFS (p=0.014) and MFS (p=0.032). Lower LRRFS was observed in stages III-IV (p=0.037). Distal parametrial extension was associated with a worse OS (p=0.01), EFS (p=0.002) and MFS (p=0.001). Delaying BT more than 50 days resulted in lower LRRFS (p=0.012), EFS (p=0.02) and OS (p=0.008). Induction chemotherapy or surgery did not affect any survival.
Conclusion: CCR and HDR BT allowed excellent
therapeutic results. Dose escalation and interstitial BT allowed more complete responses and less need for surgery. More BT units should be implemented to reduce BT delays and improve therapeutic outcomes. References: 1.PÖTTER, Richard, TANDERUP, Kari, KIRISITS, Christian, et al. The EMBRACE II study: The outcome and prospect of two decades of
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