TY - JOUR
T1 - Risk Factors for Local Failure Following Chemoradiation and Magnetic Resonance Image-Guided Brachytherapy in Locally Advanced Cervical Cancer
T2 - Results From the EMBRACE-I Study
AU - Schmid, Maximilian P.
AU - Lindegaard, Jacob C.
AU - Mahantshetty, Umesh
AU - Tanderup, Kari
AU - Jürgenliemk-Schulz, Ina
AU - Haie-Meder, Christine
AU - Fokdal, Lars U.
AU - Sturdza, Alina
AU - Hoskin, Peter
AU - Segedin, Barbara
AU - Bruheim, Kjersti
AU - Huang, Fleur
AU - Rai, Bhavana
AU - Cooper, Rachel
AU - van der Steen-Banasik, Elzbieta
AU - van Limbergen, Erik
AU - Pieters, Bradley R.
AU - Petric, Primoz
AU - Ramazanova, Dariga
AU - Ristl, Robin
AU - Kannan, Sadhana
AU - Hawaldar, Rohini
AU - Ecker, Stefan
AU - Kirchheiner, Kathrin
AU - Tan, Li Tee
AU - EMBRACE Collaborative Group
AU - Nout, Remi
AU - Nesvacil, Nicole
AU - de Leeuw, Astrid
AU - Pötter, Richard
AU - Kirisits, Christian
N1 - Publisher Copyright:
© 2023 American Society of Clinical Oncology.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - PURPOSE: To report clinical and treatment characteristics, remission and failure patterns, and risk factors for local failure (LF) from the EMBRACE-I study. MATERIALS AND METHODS: EMBRACE-I was a prospective, observational, multicenter cohort study on magnetic resonance imaging-based image-guided adaptive brachytherapy (MR-IGABT) in locally advanced cervical cancer. Treatment consisted of external beam radiotherapy, concurrent chemotherapy, and MR-IGABT. LF was defined as progressive or recurrent disease in the cervix, uterus, parametria, pelvic wall, or vagina. Competing risk analysis was used to estimate local tumor control (LC) and Cox proportional regression models for multivariable analysis and dose-response analysis. RESULTS: One thousand three hundred eighteen patients with a median follow-up of 52 months were available for this analysis. Eighty-one patients had persistent disease 3 months after end of treatment. Of those, 60 patients achieved LC at 6-9 months without further treatment, whereas 21 patients had progressive disease. In addition, 77 patients developed a local recurrence after complete remission comprising a total number of 98 LFs. LFs were located inside the MR-IGABT target volumes in 90% of patients with LF. In multivariable analysis, histology, minimal dose to 90% of high-risk clinical target volume (CTVHR), maximum tumor dimension, CTVHR > 45 cm3, overall treatment time, tumor necrosis on magnetic resonance imaging at diagnosis, uterine corpus infiltration at diagnosis and at MR-IGABT, and mesorectal infiltration at MR-IGABT had significant impact on LF. Dose-response analysis showed that a minimal dose to 90% of 85 Gy to the CTVHR led to 95% (95% CI, 94 to 97) LC 3 years postintervention for squamous cell in comparison to 86% (95% CI, 81 to 90) for adeno/adenosquamous carcinoma histology. CONCLUSION: The present study demonstrates the safety and validity of the GYN GEC-ESTRO/ICRU-89 target concept and provides large-scale evidence for dose prescription and new risk factors for LF in MR-IGABT in locally advanced cervical cancer.
AB - PURPOSE: To report clinical and treatment characteristics, remission and failure patterns, and risk factors for local failure (LF) from the EMBRACE-I study. MATERIALS AND METHODS: EMBRACE-I was a prospective, observational, multicenter cohort study on magnetic resonance imaging-based image-guided adaptive brachytherapy (MR-IGABT) in locally advanced cervical cancer. Treatment consisted of external beam radiotherapy, concurrent chemotherapy, and MR-IGABT. LF was defined as progressive or recurrent disease in the cervix, uterus, parametria, pelvic wall, or vagina. Competing risk analysis was used to estimate local tumor control (LC) and Cox proportional regression models for multivariable analysis and dose-response analysis. RESULTS: One thousand three hundred eighteen patients with a median follow-up of 52 months were available for this analysis. Eighty-one patients had persistent disease 3 months after end of treatment. Of those, 60 patients achieved LC at 6-9 months without further treatment, whereas 21 patients had progressive disease. In addition, 77 patients developed a local recurrence after complete remission comprising a total number of 98 LFs. LFs were located inside the MR-IGABT target volumes in 90% of patients with LF. In multivariable analysis, histology, minimal dose to 90% of high-risk clinical target volume (CTVHR), maximum tumor dimension, CTVHR > 45 cm3, overall treatment time, tumor necrosis on magnetic resonance imaging at diagnosis, uterine corpus infiltration at diagnosis and at MR-IGABT, and mesorectal infiltration at MR-IGABT had significant impact on LF. Dose-response analysis showed that a minimal dose to 90% of 85 Gy to the CTVHR led to 95% (95% CI, 94 to 97) LC 3 years postintervention for squamous cell in comparison to 86% (95% CI, 81 to 90) for adeno/adenosquamous carcinoma histology. CONCLUSION: The present study demonstrates the safety and validity of the GYN GEC-ESTRO/ICRU-89 target concept and provides large-scale evidence for dose prescription and new risk factors for LF in MR-IGABT in locally advanced cervical cancer.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85151312603&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36599120
U2 - 10.1200/JCO.22.01096
DO - 10.1200/JCO.22.01096
M3 - Article
C2 - 36599120
SN - 0732-183X
VL - 41
SP - 1933
EP - 1942
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 10
ER -