S82
Brachytherapy - Gynaecology
ESTRO 2026
university, Sohag, Egypt. 6 Department of Radiation Oncology, NCI, Cairo University, Giza, Egypt
Purpose/Objective: Objective: MRI-guided adaptive brachytherapy (IGِِABT) has revolutionised the treatment of locally advanced cervical cancer. This study evaluated local tumor control and morbidity following chemoradiotherapy and MRI-based IGABT. Material/Methods: Methods: This was a prospective, single-center cohort study. Patient were enrolled between January 2019 and December 2024. The inclusion criteria were patients aged ≥ 18 years with biopsy-proven squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma of ureteric cervix. FIGO stage IB3-IVA or FIGO stage IVB limited to para-aortic lymph node metastasis, with ECOG performance status < 2 years.Treatment consisted of concurrent chemoradiotherapy (weekly intravenous cisplatin 40 mg/ , 5 cycles, plus 45-50 Gy external beam radiation delivered in 1.8-2 Gy fractions) followed by MRI-based IGABT. The MRI-based IGABT target volume definition and dose reporting were according to Groupe Européen de Curiethérapie (GEC) and the European Society for Radiotherapy and Oncology (ESTRO) (GEC-ESTRO) recommendation. IGABT dose prescription was 28 Gy delivered in 4 fractions of 7 Gy each using cobalt-60 source. Local control and late morbidity were selected as primary endpoints, while progression free survival and overall survival were secondary endpoints in all patients available for analysis. The study was registered in ClinicalTrials.gov, NCT04767425 Results: Results: Sixty enrolled patients (median age 55.5 years). Squamous cell carcinoma predominant (95%); stage IIB being most common (33.3%). Median high- risk clinical target volume (CTV-HR) measured 15 ,(IQR:11.13-18.87 ). Dosimertric outcomes were excellent: Mean CTV-HR of 95.17 ± 7.76 Gy (EQD2 ₁₀ ) and mean CCTV-HR of 81.03 ± 7.38 Gy. Organ-at-risk doses remained within the acceptable limits: Bladder D2cc 81.35 ± 9.97 Gy, rectum D2cc 64.61 ± 7.62 Gy, and sigmoid D2cc 55.79 ± 8.91 Gy. Complete response was achieved in 90% of patients with minimal toxicity (1.7% Grade III Vaginal). Local control rates were exceptional at 96.7% at 17 months and 91.1% at 27 months. Disease-free survival was 75% at 40 months and 55% at 60 months, while overall survival was 80% at 40 months and 65% at 60 months. Distant metastasis (11.7%) was the predominant failure pattern, with local recurrence occurring in only 3.3% of cases.
Conclusion: Conclusion: As first implementation of MRI-guided adaptive brachytherapy in Upper Egypt, this study demonstrates that advanced image-guided techniques can be successfully established in resource limited settings, achieving excellent local control with minimal treatment-related toxicity. The predominance of distant failure suggests that intensification of systemic therapy warrants investigation in future trials. Keywords: MRI Adaptive, Image Guided Brachytherapy References: 1- Pötter R, Tanderup K , Maximilian , et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. Lancet Oncol 2021; 22: 538–47.2- Pötter R, Tanderup K, Kirisits C et al., The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC- ESTRO GYN working group and the EMBRACE studies. Clinical and Translational Radiation Oncology. 2018;9:48–60.3- Pötter R, Dimopoulos J, Georg P, et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol 2007; 83: 148–55.
Made with FlippingBook - Share PDF online