Abstract
PURPOSE
To demonstrate the feasibility of treating cervical cancer patients with MRI-guided
brachytherapy (MRgBT) using 24 Gy in 3 fractions (F) versus a standard, more resource-intensive
regimen of 28 Gy in 4F, and its ability to meet EMBRACE II planning aims.
METHODS AND MATERIALS
A retrospective review of 224 patients with FIGO Stage IB–IVA cervical cancer treated
with 28 Gy/4F (n = 91) and 24 Gy/3F (n = 133) MRgBT between 2016-2021 was conducted. Multivariable linear regression models
were fitted to compare dosimetric parameters between the two groups, adjusting for
CTVHR and T stage.
RESULTS
Most patients had squamous cell carcinoma, T2b disease, and were treated with intracavitary
applicator plus interstitial needles (96%). The 28 Gy/4F group had higher CTVHR (median 28 vs. 26 cm3, p = 0.04), CTVIR D98% (mean 65.5 vs. 64.5 Gy, p = 0.03), rectum D2cm3 (mean 61.7 vs. 59.2 Gy, p = 0.04) and bladder D2cm3 (81.3 vs. 77.9 Gy, p = 0.03). There were no significant differences in the proportion of patients meeting
the EMBRACE II OAR dose constraints and planning aims, except fewer patients treated
with 28 Gy/4F met rectum D2cm3 < 65 Gy (73 vs. 85%, p = 0.027) and ICRU rectovaginal point < 65 Gy (65 vs. 84%, p = 0.005).
CONCLUSIONS
Cervical cancer patients treated with 24 Gy/3F MRgBT had comparable target doses and
lower OAR doses compared to those treated with 28 Gy/4F. A less-resource intense fractionation
schedule of 24 Gy/3F is an alternative to 28 Gy/4F in cervix MRgBT.
Keywords
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Article info
Publication history
Published online: December 16, 2022
Accepted:
November 11,
2022
Received in revised form:
November 7,
2022
Received:
August 19,
2022
Publication stage
In Press Corrected ProofFootnotes
Disclosures: This work was supported by a Conquer Cancer- Bristol-Myers Squibb Global Oncology Young Investigator Award to Aba Anoa Scott. Any opinions, findings, and conclusions expressed in this material are those of the authors and do not necessarily reflect those of the American Society of Clinical Oncology or Conquer Cancer, and the Princess Margaret Cancer Foundation - Department Radiation Oncology Academic Enrichment Fund. The funding sources had no role in any of the following: study design, collection, analysis or interpretation of data, writing of the manuscript and decision to submit the manuscript for publication.
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© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
