Decoding the Influence of External Beam Radiotherapy to Brachytherapy Duration and Overall Treatment on Response and Early Recurrences in Cervical Cancer Patients Treated with Chemoradiation

Overview

Journal Radiat Oncol J

Specialty Oncology

Date 2025 Jan 3

PMID 39748526

Authors

Abhishek Krishna

Bharat Sai Makkapatti

M S Athiyamaan

Dilson Lobo

Challapalli Srinivas

Johan Sunny

Vaishak Jawahar

Harleen Kaur

Sourjya Banerjee

Affiliations

Soon will be listed here.

Abstract

Purpose: Cervical cancer is a significant global health issue affecting approximately 600,000 women each year. This study aimed to address the knowledge gaps surrounding the influence of treatment time parameters, including the duration of external beam radiotherapy (EBRT) to brachytherapy and overall treatment duration, on early recurrences.

Materials And Methods: Details on demographics, tumor characteristics, treatment details, and outcomes in patients undergoing chemoradiation and brachytherapy for cervical cancer were collected from the medical records. Early recurrence was defined as tumor reappearance within 6 months after treatment in patients with an initial complete response. Statistical analyses included descriptive statistics chi-square tests, independent t-tests, and logistic regression.

Results: A total of 288 cervical cancer patients were included. Stage IIB was the most common stage and 93% of patients had a complete response, 4.5% partial response, and 3.1% had progressive disease at 3rd month. At 6 months, 8% experienced early. The average interval between EBRT and brachytherapy was 10.4 ± 4.2 days among the no recurrence group and 12.3 ± 4.5 days among early recurrence group. A total of 203 patients had a gap of 10 or fewer days and 123 patients had a gap of more than 10 days between EBRT and brachytherapy. Difference was observed in the overall treatment time between the two groups had significant differences (no recurrence group, 61.6 ± 11.5 days; early recurrence group, 73.8 ± 8.8 days; p < 0.001).

Conclusion: The study revealed that longer overall treatment durations were associated with a higher risk of early recurrences, highlighting the need for further investigation and optimized treatment strategies.

References

Erridge S, Kerr G, Downing D, Duncan W, Price A . The effect of overall treatment time on the survival and toxicity of radical radiotherapy for cervical carcinoma. Radiother Oncol. 2002; 63(1):59-66. DOI: 10.1016/s0167-8140(02)00012-9. View

Cho W, Kim Y, Park W, Yang K, Kim H, Cha H . Para-aortic lymph node recurrence after curative radiotherapy for cervical cancer. Int J Gynecol Cancer. 2019; 29(7):1116-1120. DOI: 10.1136/ijgc-2019-000615. View

Hirst D, Robson T . Molecular biology: the key to personalised treatment in radiation oncology?. Br J Radiol. 2010; 83(993):723-8. PMC: 3473406. DOI: 10.1259/bjr/91488645. View

LaVigne A, Triedman S, Randall T, Trimble E, Viswanathan A . Cervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery. Gynecol Oncol Rep. 2017; 22:16-20. PMC: 5602511. DOI: 10.1016/j.gore.2017.08.004. View

Gasinska A, Fowler J, Lind B, Urbanski K . Influence of overall treatment time and radiobiological parameters on biologically effective doses in cervical cancer patients treated with radiation therapy alone. Acta Oncol. 2004; 43(7):657-66. DOI: 10.1080/02841860410018511. View

Lanciano R, Pajak T, Martz K, Hanks G . The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. Int J Radiat Oncol Biol Phys. 1993; 25(3):391-7. DOI: 10.1016/0360-3016(93)90058-4. View

Huang Z, Mayr N, Gao M, Lo S, Wang J, Jia G . Onset time of tumor repopulation for cervical cancer: first evidence from clinical data. Int J Radiat Oncol Biol Phys. 2012; 84(2):478-84. PMC: 3369115. DOI: 10.1016/j.ijrobp.2011.12.037. View

Fyles A, Keane T, Barton M, Simm J . The effect of treatment duration in the local control of cervix cancer. Radiother Oncol. 1992; 25(4):273-9. DOI: 10.1016/0167-8140(92)90247-r. View

Mabuchi S, Isohashi F, Yoshioka Y, Temma K, Takeda T, Yamamoto T . Prognostic factors for survival in patients with recurrent cervical cancer previously treated with radiotherapy. Int J Gynecol Cancer. 2010; 20(5):834-40. DOI: 10.1111/IGC.0b013e3181dcadd1. View

10.

Coles C, Burgess L, Tan L . An audit of delays before and during radical radiotherapy for cervical cancer--effect on tumour cure probability. Clin Oncol (R Coll Radiol). 2003; 15(2):47-54. DOI: 10.1053/clon.2002.0178. View

11.

Wang J, Wang T, Yang Y, Chai Y, Shi F, Liu Z . Patient age, tumor appearance and tumor size are risk factors for early recurrence of cervical cancer. Mol Clin Oncol. 2015; 3(2):363-366. PMC: 4360871. DOI: 10.3892/mco.2014.465. View

12.

. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008; 26(35):5802-12. PMC: 2645100. DOI: 10.1200/JCO.2008.16.4368. View

13.

Gichangi P, Bwayo J, Estambale B, Rogo K, Njuguna E, Ojwang S . HIV impact on acute morbidity and pelvic tumor control following radiotherapy for cervical cancer. Gynecol Oncol. 2005; 100(2):405-11. DOI: 10.1016/j.ygyno.2005.10.006. View

14.

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

15.

Klopp A, Eifel P . Biological predictors of cervical cancer response to radiation therapy. Semin Radiat Oncol. 2012; 22(2):143-50. DOI: 10.1016/j.semradonc.2011.12.009. View

16.

Peiretti M, Zapardiel I, Zanagnolo V, Landoni F, Morrow C, Maggioni A . Management of recurrent cervical cancer: a review of the literature. Surg Oncol. 2012; 21(2):e59-66. DOI: 10.1016/j.suronc.2011.12.008. View

17.

Bese N, Hendry J, Jeremic B . Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods for compensation. Int J Radiat Oncol Biol Phys. 2007; 68(3):654-61. DOI: 10.1016/j.ijrobp.2007.03.010. View

18.

Tanderup K, Fokdal L, Sturdza A, Haie-Meder C, Mazeron R, Van Limbergen E . Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol. 2016; 120(3):441-446. DOI: 10.1016/j.radonc.2016.05.014. View

19.

Gennigens C, De Cuypere M, Hermesse J, Kridelka F, Jerusalem G . Optimal treatment in locally advanced cervical cancer. Expert Rev Anticancer Ther. 2021; 21(6):657-671. DOI: 10.1080/14737140.2021.1879646. View