Clinical outcomes of definitive chemoradiation followed by intracavitary pulsed-dose rate image-guided adaptive brachytherapy in locally advanced XXXX .

@entity1 @entity137 @entity5 @entity3846 @entity3847
OBJECTIVE: To report the outcomes and late @entity137 of @entity1 with locally advanced @entity5 treated with concomitant chemoradiation (CRT) followed by intracavitary image-guided adaptive brachytherapy (IGABT). METHODS: Data from consecutive @entity1 with histologically proven stage @entity5 treated with curative intent in a single institution were analyzed. After pelvic +/- para-aortic external-beam radiation therapy, they received pulsed-dose rate IGABT following GEC-ESTRO recommendations. RESULTS: Two hundred and twenty-five @entity1 were enrolled. Sixty-five percent were stage>= IIB according to FIGO classification. Ninety-five percent received CRT. Mean D90 to HR and IR-CTV were 80.4+/-10.3Gy and 67.7+/-6.1Gy. After a median follow-up of 38.8months, 3-year local control and overall survival rates were 86.4% and 76.1%, respectively. A trend for a detrimental effect of @entity5 stage on local control rates was observed with 3-year local control rates of 100% for stages @entity3846 and IIA, 90.5 for @entity3847 , 85.8% for IIB, 50% for IIIA, 77.1 for IIIB, and 66.7% for @entity5 (p=0.06). Local control rates at 3years were 95.6% in the group of @entity1 with D90 of HR-CTV>= 85Gy, 88.8% in those with D90 between 80 and 85Gy, and 80% when D90<80Gy (p=0.018). Eighteen severe late gastrointestinal and urinary effects affecting 14 @entity1 were reported corresponding with a crude incidence of 6.6%. CONCLUSIONS: CRT followed by IGABT provides high local control rates with limited @entity137 . Reaching high doses is mandatory to achieve local control and interstitial brachytherapy is necessary in advanced diseases.
