S63
Brachytherapy - Gynaecology
ESTRO 2026
Digital Poster 2302
Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Rome, Italy
Image-guided interventional radiotherapy (modern brachytherapy) boost for vaginal cuff recurrences Valentina Lancellotta 1 , Maria Concetta La Milia 1 , Martina De Angeli 1 , Bruno Fionda 1 , Enrico Rosa 1 , Elisa Placidi 1 , Alessia Nardangeli 2 , Francesca Tortoreto 3 , Pierpaolo Dragonetti 1 , Lucia Di Maio 1 , Rosa Autorino 1 , Gabriella Macchia 4 , Maria Antonietta Gambacorta 1 , Luca Tagliaferri 1 1 Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Rome, Italy. 2 Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 3 UOC di Radioterapia Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy. 4 Department of Radiation Oncology, Responsible Research Hospital, Campobasso, Italy Purpose/Objective: Approximately 10–15% of patients undergoing surgery for gynaecological cancer experience pelvic recurrences, with about 75% of these recurrences localized to the vaginal cuff. Definitive radio±chemotherapy (RT+/-CT), followed by image- guided interventional radiotherapy (IG-IRT, also referred to as modern brachytherapy, BT), is recognized as an effective treatment strategy. This study aims to present the outcomes of a series of vaginal cuff recurrences treated with radio±chemotherapy, followed by IG-IRT. Material/Methods: We retrospectively analysed patients with vaginal cuff recurrences who received RT+/- CT followed by complementary IG-IRT with curative intent between January 2019 and September 2024. The total dose of external beam RT was 45 Gy. OncentraBrachy treatment planning system and a Flexitron (Elekta, Stockholm, Sweden) afterloading machine with a 192- Ir source were used for IG-IRT treatment. The IG-IRT total dose was 28 Gy over four high dose rate (HDR) fractions in order to achieve between 85Gy - 95 Gy EQD2 α / β 10 to the high risk (HR)-clinical target volume CTV and 60 Gy EQD2 α / β 10 to intermediate risk (IR)- CTV. The primary study endpoint was the local control (LC), while secondary endpoints included metastasis- free survival (MFS), overall survival (OS), cancer specific survival (CSS), and the rate and severity of acute and late toxicities. Actuarial outcomes were analysed using the Kaplan-Meier method, and differences among subgroups were evaluated by log-rank tests, assuming the proportional end-points assumption holds. Statistical analysis was carried out using SPSS statistical software (IBM Corp. Version 20.0. Armonk, NY).
Purpose/Objective: Vaginal carcinoma (VC) is a rare malignancy accounting for 1% to 2% of all gynecological cancers. Definitive radio-chemotherapy (RCT). The aim of this study was to report the results of our mono-institutional series of vaginal cancer patients treated with RCT followed by image- guided interventional radiotherapy (IG-IRT, modern brachytherapy, BT). Material/Methods: We retrospectively analysed 53 patients with primary vaginal cancer who received RCT followed by IRT with curative intent between January 2019 and December 2024. The primary study endpoint was the local control (LC), secondary endpoints were the distant metastasis free survival (DMFS), cancer specific survival (CSS), and the rate and severity of acute and late toxicities. Results: Twenty-seven patients were stage II, 22 patients’ stage III and 4 stage IVB (International Federation of Gynecology and Obstetrics stages 2008). The median total dose of external beam RT was 45Gy (range 45Gy- 70Gy). OncentraBrachy treatment planning system and a Flexitron (Elekta, Stockholm, Sweden) device with a 192-Ir source were used for IRT treatment. The median IRT total dose was 28 Gy (range 10Gy-28Gy). One patient nor received chemotherapy. The median follow-up was 30 months (4-87 months), while the median Overall treatment time (OTT) was 60.5 days (28-97 days). 1-year LC, DMFS, and CSS rates were 85%, 83%, 88.1%, 85%, respectively. Acute toxicity was registered in 25 patients: 12 cases of cutaneous toxicities (6G1, 5G2, and 1 G3), 11 cases of genito- urinary ones (8 G1, 3 G2), 8 gastro-intestinal ones (2G1, 6G2). Regarding late toxicities, only vaginal ones were registered: one G3 stenosis, three G2 stenosis, 7 G1 stenosis, one G1 teleangectasia, and 3 G1 atrophy. At univariate analysis, the rate of distant metastases differed significantly between node- positive vs node-negative patients, as well as between FIGO stage I–II and stage III–IV, with p-values of 0.047 and 0,043, respectively. CSS differed significantly between patients with complete response on pre-IRT MRI compared with partial response. Conclusion: In this series, definitive CRT followed by IG-IRT was an effective treatment modality for primary vaginal cancer Keywords: vaginal cancer; brachytherapy; outcomes
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