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Change in patterns of failure after image-guided brachytherapy for cervical cancer: analysis from the RetroEMBRACE study.

In International Journal of Radiation Oncology, Biology, Physics.
By: Tan LT.
Contributor(s): Pötter R | Sturdza A [Corresponding Author ] | Fokdal L | Haie-Meder C | Schmid M | Gregory D | Petric P | Jürgenliemk-Schulz I | Gillham C | Van Limbergen E | Hoskin P | Tharavichitkul E | Villafranca E | Mahantshetty U | Kirisits C | Lindegaard J | Kirchheiner K | Tanderup K.
Material type: materialTypeLabelArticlePublisher: 2019Description: .Subject(s): Brachytherapy | RetroEMBRACE study | Cervical cancer In: International Journal of Radiation Oncology, Biology, PhysicsSummary: BACKGROUND: and Purpose: Image-guided adaptive brachytherapy (IGABT) for cervical cancer improves pelvic control and survival across all stages. Improvement in pelvic control is larger in advanced stages but improvement in survival is similar across stages. This paper analyses the patterns of failure in the RetroEMBRACE cohort to investigate this discrepancy. MATERIAL AND METHODS: 731 patients from 12 institutions treated with chemo-radiotherapy and MRI or CT-based IGABT were evaluated. The pattern of failure at time of first relapse was analysed. RESULTS: 325 failures (single and synchronous) occurred in 222/731 (30%) patients (local 9%; regional 6%; pelvic (local and/or regional) 13%; paraaortic node (PAN) 9%; systemic 21%; distant (systemic + PAN) 24%). Of the 222 patients with treatment failure, 21% had pelvic failure alone, 57% had distant failure alone and 23% had both pelvic and distant failure. 40-50% of all failures occurred in the first year with a further 20-30% occurring in the second year. While local, regional and PAN failure tended to plateau after year 3, systemic failure continued to occur up to 10 years. CONCLUSIONS: Implementation of IGABT has changed the patterns of relapse after chemo-radiotherapy for cervical cancer. The predominant failure of after IGABT is systemic while the predominant failure with conventional brachytherapy is pelvic. Effective treatments to eradicate micro-metastases in PAN and distant organs are needed in addition to IGABT and chemo-radiotherapy to maximize local, regional, PAN and systemic control and improve survival.
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Address for Correspondence : alina.sturdza@akhwien.at

BACKGROUND:
and Purpose: Image-guided adaptive brachytherapy (IGABT) for cervical cancer improves pelvic control and survival across all stages. Improvement in pelvic control is larger in advanced stages but improvement in survival is similar across stages. This paper analyses the patterns of failure in the RetroEMBRACE cohort to investigate this discrepancy.

MATERIAL AND METHODS:
731 patients from 12 institutions treated with chemo-radiotherapy and MRI or CT-based IGABT were evaluated. The pattern of failure at time of first relapse was analysed.

RESULTS:
325 failures (single and synchronous) occurred in 222/731 (30%) patients (local 9%; regional 6%; pelvic (local and/or regional) 13%; paraaortic node (PAN) 9%; systemic 21%; distant (systemic + PAN) 24%). Of the 222 patients with treatment failure, 21% had pelvic failure alone, 57% had distant failure alone and 23% had both pelvic and distant failure. 40-50% of all failures occurred in the first year with a further 20-30% occurring in the second year. While local, regional and PAN failure tended to plateau after year 3, systemic failure continued to occur up to 10 years.

CONCLUSIONS:
Implementation of IGABT has changed the patterns of relapse after chemo-radiotherapy for cervical cancer. The predominant failure of after IGABT is systemic while the predominant failure with conventional brachytherapy is pelvic. Effective treatments to eradicate micro-metastases in PAN and distant organs are needed in addition to IGABT and chemo-radiotherapy to maximize local, regional, PAN and systemic control and improve survival.

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