S467
Clinical - Gynaecological
ESTRO 2026
Wongsuwan 1,2 , Ratchapas Romrattaphan 1,2 , Nantakan Apiwarodom 1,2 , Yaowalak Chansilpa 1,2 , Supamon Nitipitch 1 , Natthanicha Sauenram 1 , Naritsa Rotmuenwai 1 1 Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2 Siriraj Brachytherapy Center (SiBTC), Siriraj Center of Excellence (SiCOE), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 3 Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Tx, USA Purpose/Objective: To evaluate outcomes of locally advanced cervical cancer (LACC) treated with concurrent chemoradiation (CCRT) and image-guided adaptive brachytherapy (IGABT), comparing patients whose treatment adhered to EMBRACE-II protocol with those who did not. The study aimed to determine whether EMBRACE-compliant treatment affects outcomes in real-world practice. Material/Methods: This retrospective study reviewed 188 patients with LACC (FIGO2018 stages IB3–IVA) treated with definitive CCRT between 2020 and 2022. All received external beam radiotherapy (EBRT) followed by IGABT. Patients were classified into four groups:1.EMBRACE-II (EMB): patients enrolled in the trial.2.Real-world EMBRACE Radiation– compliant (RW EMB-RADcom): treated per EMBRACE II, including VMAT 45Gy/25 fractions and MRI-IGABT with applicator-in- place for ≥ 1 fraction.3.Real-world EMBRACE Radiation–noncompliant (RW EMB- RADnoncom): any deviation from EMBRACE II in one or more treatment components.4.HYPO: treated with 44Gy/20 fractions over 42 days.Baseline characteristics, treatment parameters, and follow-up outcomes were collected. Clinical endpoints included disease control and survival. 49-day Overall treatment time (OTT) cut-point was analyzed for event-free survival (EFS) and overall survival (OS). Descriptive
and Kaplan–Meier analyses were performed. Adverse events (AEs) were graded using CTCAE v5.0. Results: Of 188 patients, 22%, 33%, 37%, and 8% were categorized as EMB, RW EMB-RADcom, RW EMB-RADnoncom, and HYPO, respectively. The EMB group had the longest median follow-up (30.3 months). Both RW groups had significantly higher stages than the EMB and HYPO groups. Para-aortic nodal metastasis was most frequent in the RW EMB-RADcom group (44%), followed by RW EMB- RADnoncom (21%) and EMB (5%). Extended- field irradiation was used in 40% of the RW
EMB-RADcom, 20% of the RW EMB- RADnoncom, and 5% of the EMB
groups.Disease control and survival rates did not differ significantly among groups (Figure). 2-year LC/LRC/DMC/EFS/OS were 91/82/78/64/81%. In OTT analysis, the RW EMB-RADnoncom group with OTT ≤ 49 days had better overall survival than the longer OTT (p = 0.096). Conversely, the impact of OTT was not statistically significant in other OS or EFS subgroups. The HYPO group had higher rates of grade ≥ 3 gastrointestinal AEs (p=0.07), while higher grade ≥ 3 genitourinary AEs were observed in the RW EMB-RADcom group without statistical significance.
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