Treatment outcomes of computer tomography-guided brachytherapy in cervical cancer in Hong Kong: a retrospective review
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Authors
Chan, Wing-Lok
Cheng, Matthew Ho-Fai
Wu, Jacky Tsun-Kit
Choi, Cheuk-Wai
Tse, Rosa Piu-Ying
Ho, Patty Piu-Ying
Cheung, Emina Edith
Cheung, Andy
Test, Ka-Yu
Chan, Karen Kar-Loen
Issue Date
2022-08-15
Type
Article
Language
en_US
Keywords
Cervical Cancer , Image-Guided Brachytherapy , Long-Term Outcome , Adenocarcinoma , Local Control , Computer Tomography , Survival
Alternative Title
Abstract
Simple Summary
This retrospective study reviews 135 patients with locally advanced cervical cancer treated with chemo-radiotherapy with image-guided adaptive brachytherapy with CT guidance. The study has a long follow-up period of 53.6 months. The outcome was excellent with a five-year local control, pelvic control, distant metastasis-free survival and overall survival rates being 90.7%, 84.2%, 80.0% and 87.2%, respectively. Adenocarcinoma was significantly associated with worse local control, pelvic control, distant metastasis-free survival and overall survival rates.
Abstract
(1) Background: To report the long-term clinical outcomes of computer-tomography (CT)-guided brachytherapy (BT) for locally advanced cervical cancer. (2) Methods: A total of 135 patients with FIGO stage IB-IVA cervical cancer treated with definitive radiotherapy +/− chemotherapy with an IGABT boost at Queen Mary Hospital, Hong Kong, between November 2013 and December 2019 were included. Treatment included pelvic radiotherapy 40 Gy/20 Fr/4 weeks +/− chemotherapy then CT-guided BT (7 Gy × 4 Fr) and a sequential parametrial boost. The primary outcome was local control. Secondary outcomes were pelvic control, distant metastasis-free survival, overall survival (OS) and late toxicities. (3) Results: The median follow-up was 53.6 months (3.0–99.6 months). The five-year local control, pelvic control, distant metastasis-free survival and OS rates were 90.7%, 84.3%, 80.0% and 87.2%, respectively. The incidence of G3/4 long-term toxicities was 6.7%, including proctitis (2.2%), radiation cystitis (1.5%), bowel perforation (0.7%), ureteric stricture (0.7%) and vaginal stenosis and fistula (0.7%). Patients with adenocarcinomas had worse local control (HR 5.82, 95% CI 1.84–18.34, p = 0.003), pelvic control (HR 4.41, 95% CI 1.83–10.60, p = 0.001), distant metastasis-free survival (HR 2.83, 95% CI 1.17–6.84, p = 0.021) and OS (HR 4.38, 95% CI: 1.52–12.67, p = 0.003) rates. Distant metastasis-free survival was associated with HR-CTV volume ≥ 30 cm3 (HR 3.44, 95% CI 1.18–9.42, p = 0.025) and the presence of pelvic lymph node (HR 3.44, 95% CI 1.18–9.42, p = 0.025). OS was better in patients with concurrent chemotherapy (HR 4.33, 95% CI: 1.40–13.33, p = 0.011). (4) Conclusions: CT-guided BT for cervical cancer achieved excellent long-term local control and OS. Adenocarcinoma was associated with worse clinical outcomes. (4) Conclusion: CT-guided BT for cervical cancer achieved excellent long-term local control and OS. Adenocarcinoma was associated with worse clinical outcomes.
Description
Citation
Chan, W. L., Cheng, M. H., Wu, J. T., Choi, C. W., Tse, R. P., Ho, P. P., Cheung, E. E., Cheung, A., Test, K. Y., Chan, K. K., Ngan, H. Y., Siu, S. W., Ngan, R. K., & Lee, A. W. (2022). Treatment Outcomes of Computer Tomography-Guided Brachytherapy in Cervical Cancer in Hong Kong: A Retrospective Review. Cancers, 14(16), 3934. https://doi.org/10.3390/cancers14163934
Publisher
Cancers