S486
Clinical - Gynaecological
ESTRO 2026
metastases, 17% brain metastases, 10.6% parenchymal lesions, and 2.1% bone lesions. The median patient age was 67 years (range, 35–83). The most frequently used technique was SBRT (53.2%), with the most common prescribed dose being 30 Gy in 3 Fr. A total of 9 patients (19.1%) received concomitant systemic therapy. Additionally, 9 patients (19.6%) received a second irradiation and 1 patient a third irradiation due to oligoprogression. In the overall analysis, a complete response (CR) was observed in 42.6% of treated lesions, partial response (PR) in 31.9%, stable disease in 17%, and progression in 6.4% of cases. Two-year local control was 86.7%. Two-year PFS was 32.1%, while two-year CSS was 78.1%. The cumulative incidence of acute and late grade 2 adverse effects was 19% and 2.1%, respectively. No cases of acute or late grade ≥ 3 toxicity were recorded, demonstrating a favorable safety profile. Conclusion: Metastasis-directed therapy is an effective and safe local treatment option for managing patients with oligometastatic gynecologic cancer, showing high local control rates and low toxicity. Prospective studies are needed to validate these results and assist in patient selection. Keywords: Metastasis-Directed Radiotherapy Digital Poster 4761 Adjuvant Small-Field Pelvic Radiotherapy after Radical Hysterectomy in Intermediate-Risk Early-Stage Cervical Cancer: Long-Term Overall Survival Tomás Walter 1,2 , Maximiliano Reyes 1,2 , María José Maluk 1,2 , Darlett Folch 1,2 , Francisco Perez 1,2 , Gabriel Lazcano 1,2 , Gabriel Veillón 1,2 , Constanza Hormazabal 1 , Isabella Liedtke 1 , Anaís Molina 2 , Gonzalo Lanza 2 , Josefa Giusti- Bilz 2 , José Solís 1,2 1 Radiation Oncology Department, Hospital Carlos Van Buren, Valparaíso, Chile. 2 Facultad
de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
Purpose/Objective: Adjuvant external beam radiotherapy (EBRT) after radical hysterectomy is recommended for intermediate-risk cervical cancer defined by Sedlis criteria, reducing pelvic recurrence at the cost of treatment-related morbidity. The use of a de-escalated pelvic CTV is an attractive strategy to reduce adverse effects (AE) in comparison to standard whole-pelvis radiotherapy, but data remain scarce (1,2). This study evaluates long-term overall survival (OS) and AE in patients treated with adjuvant small-field pelvic EBRT. Material/Methods: We conducted a single-center retrospective cohort study of patients with FIGO 2009 stage IB1–IB2 cervical cancer treated between March 2009 and May 2023. Eligibility required radical hysterectomy with bilateral pelvic lymphadenectomy and ≥ 2 Sedlis risk factors (tumor size, depth of stromal invasion, lymph-vascular space invasion). Patients with nodal involvement, positive margins, or parametrial invasion were excluded. All received adjuvant small-field pelvic EBRT, considering L5-S1 as the upper CTV limit. OS was estimated using the Kaplan–Meier method. Acute gastrointestinal (GI) and genitourinary (GU) AE were graded using RTOG criteria. Results: Thirty-three patients met inclusion criteria. Median follow-up was 120 months. Estimated 5-year OS was 88.9%. All patients completed radiotherapy without interruptions. Acute AE were grade 1–2 GI in 100% and grade 1–2 GU in 39.3% (n=13), with no grade ≥ 3 events, treatment discontinuations, or invasive procedures related to AE. The prescribed doses for treatment were 3% (n=1) 45 Gy in 25 fractions, 3% (n=1) 48.6 Gy in 27 fractions, 12% (n=4) 50 Gy in 25 fractions and 81% (n=27) 50.4 Gy in 28 fractions. Conclusion: Adjuvant small-field pelvic EBRT
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