Interstitial Needles Versus Intracavitary Applicators Only for Locally Advanced Cervical Cancer: Results from Real-life Dosimetric Comparisons

Overview

Journal Front Oncol

Specialty Oncology

Date 2024 Apr 3

PMID 38567146

Authors

Abel Cordoba

Estelle Gesta

Alexandre Escande

Alexandra Noeuveglise

Romain Cayez

Adrien Halty

Mohamed Tahar Ladjimi

Fabrice Narducci

Delphine Hudry

Carlos Martinez Gomez

Sofia Cordoba

Marie-Cecile Le Deley

Mael Barthoulot

Eric F Lartigau

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Image-guided adapted brachytherapy (IGABT) is superior to other radiotherapy techniques in the treatment of locally advanced cervical cancer (LACC). We aimed to investigate the benefit of interstitial needles (IN) for a combined intracavitary/interstitial (IC/IS) approach using IGABT over the intracavitary approach (IC) alone in patients with LACC after concomitant external beam radiotherapy (EBRT) and chemotherapy.

Materials And Methods: We included consecutive patients with LACC who were treated with IC/IS IGABT after radiochemotherapy (RCT) in our retrospective, observational study. Dosimetric gain and sparing of organs at risk (OAR) were investigated by comparing the IC/IS IGABT plan with a simulated plan without needle use (IC IGABT plan) and the impact of other clinical factors on the benefit of IC/IS IGABT.

Results: Ninety-nine patients were analyzed, with a mean EBRT dose of 45.5 ± 1.7 Gy; 97 patients received concurrent chemotherapy. A significant increase in median D90% High Risk Clinical target volume (HR-CTV) was found for IC/IS (82.8 Gy) vs IC (76.2 Gy) (p < 10). A significant decrease of the delivered dose for all OAR was found for IC/IS vs IC for median D2 to the bladder (77.2 Gy), rectum (68 Gy), sigmoid (53.2 Gy), and small bowel (47 Gy) (all p < 10).

Conclusion: HR-CTV coverage was higher with IC/IS IGABT than with IC IGABT, with lower doses to the OAR in patients managed for LACC after RCT. Interstitial brachytherapy in the management of LACC after radiotherapy provides better coverage of the target volumes, this could contribute to better local control and improved survival of patients.

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