KEY POINTS
- The Austrian referral model included 89 patients with locally advanced cervical cancer treated across a nationwide network. EBRT was delivered at nine referring institutions, while all patients travelled to a single tertiary centre for centralized MR-guided adaptive brachytherapy.
- All patients received four fractions of MR-IGABT with MRI-based target delineation according to GEC-ESTRO principles. 60% had nodal involvement, including 17% with para-aortic nodes, reflecting a relatively high-risk population.
- Despite the inter-institutional workflow, median overall treatment time was 50 days, with only 6.5 days between EBRT and brachytherapy, remaining within the commonly recommended 56-day treatment window.
- Treatment was technically intensive: 87% received combined intracavitary/interstitial brachytherapy, with a median of six needles, and median CTVHR D90 was approximately 91 Gy EQD2.
- At three years, estimated local control was 95%, pelvic nodal control 95%, overall survival 74% and recurrence-free survival 65%. Five-year overall survival was 69%, with distant metastases representing the dominant mode of failure.
- Median OAR D2cm³ values were 77 Gy for bladder, 62 Gy for rectum, 62 Gy for sigmoid and 59 Gy for bowel, broadly demonstrating adherence to EMBRACE II dosimetric objectives despite decentralized EBRT.
- Grade ≥3 morbidity requiring medical intervention occurred in 26%; the most frequent events were hydronephrosis (7%), transfusion-requiring anemia (6%), bladder toxicity (6%), vaginal stenosis (5%) and vesicovaginal fistula (3%). Toxicity interpretation is limited by the retrospective nature of follow-up.
CLINICAL TAKEAWAY
Centres do not necessarily need to reproduce the full MR-IGABT infrastructure locally to provide modern cervical brachytherapy. With early referral and tightly coordinated EBRT and brachytherapy, a centralized specialist network maintained guideline-level dose delivery, treatment duration and local control.