S443
Clinical - Gynaecological
ESTRO 2026
evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clinical and translational radiation oncology, 2018, vol. 9, p. 48-60. Keywords: Cervical Cancer, IMRT, HDR brachytherapy.
standard-of-care intensity-modulated photon radiotherapy (IMRT) or intensity-modulated proton beam therapy (IMPT). Patients will receive 45-50.4 Gy in 1.8 Gy fractions 5 times a week. In both treatment arms, CT-based 3D-treatment planning with full and empty bladder will be performed and the CTV contoured according to the RTOG consensus guidelines. Platinum-based chemotherapy can be administered if indicated. The primary endpoint of the study is the dose exposure of the pelvic skeleton as measured by the V10. The key secondary endpoint is any hematotoxicity (anemia, leukopenia, thrombopenia) ≥ CTCAE II° during radiotherapy and up to 2 weeks afterwards. Secondary endpoints are more detailed evaluation of hematotoxicity grading, other toxicities like gastrointestinal and urogenital, patient-reported outcomes, assessment of incidence of pelvic insufficiency fractures, quality of life measured by the QLQ C30 questionnaire and oncological outcome measures like Progression-free survival (PFS) and Overall survival (OS). The final protocol was approved by the ethics committee of the University of Heidelberg, Germany. Results: Postoperative irradiation plays a crucial role in distinct subgroups of cervical and endometrial cancer patients by reducing the risk of locoregional recurrence and improving overall survival. However, even modern photon-based radiation therapy techniques like IMRT can cause acute or chronic myelosuppression resulting in immune suppression. This can limit the ability to deliver concurrent or sequential chemotherapy which might impact overall survival. Proton beam therapy has shown promising results in minimizing radiation- induced toxicities by precise delivery of radiation to the area of interest while sparing surrounding critical organs [1]. A representative dose distribution for IMRT and IMPT is illustrated in Figure 1 and 2. Since especially low dose exposure to the bone marrow is associated with acute
Digital Poster 2122
Postoperative proton beam therapy for uterine cervical or endometrial cancer (APROVE II) – a prospective, multicenter, randomized trial Lars B. Wessel 1,2 , Fabian Eberle 3,4 , Friderike K. Longarino 1,5 , Lisa Oettl 1 , Max Niemeyer 3,4 , Jan-Henrik Bolten 1,2 , Eva Meixner 1,2 , Semi Harrabi 1,2 , Fabian Weykamp 1,2 , Jürgen Debus 1,2 , Sebastian Adeberg 3,4 , Nathalie Arians 1,2 1 Department of Radiation Oncology and Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany. 2 Department of Radiation Oncology, National Center for Tumor diseases (NCT), Heidelberg, Germany. 3 Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany. 4 Marburg Ion-Beam Therapy Center (MIT), Department of Radiotherapy and Radiation Oncology, Marburg, Germany. 5 Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany Purpose/Objective: To assess the potential of proton beam therapy in the postoperative management of uterine cervical or endometrial cancer patients to reduce dose exposure of the pelvic skeleton and thus hematotoxicity. Material/Methods: The APROVE II trial is a prospective, multicenter, randomized, 2-armed phase II trial. 66 patients with uterine cervical or endometrial cancer with indication for postoperative pelvic radiotherapy after surgery will be randomized to receive either
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