KEY POINTS
- This retrospective consecutive cohort included 237 patients with FIGO 2018 stage I–IVA cervical cancer treated with curative-intent radiotherapy from 2019–2021. Disease was advanced in many patients: 48.5% had stage III and 8.4% stage IV disease, while 83.5% had squamous histology.
- Pelvic external-beam radiotherapy delivered 45–50.4 Gy in 23–28 fractions, with weekly cisplatin 40 mg/m² or carboplatin AUC 2 when indicated. All patients then received CT-guided HDR brachytherapy at 7 Gy × 4 fractions.
- Adaptive intracavitary/interstitial treatment was used in 285/945 brachytherapy fractions (30.2%). Mean cumulative HR-CTV D90 was 85.4 ± 2.7 Gy EQD2, while bladder, rectum and sigmoid D2cc averaged 77.5, 65.9 and 61.2 Gy EQD2, respectively.
- At six weeks, 222/237 patients (93.7%) had complete response. With median local-control follow-up of 59.9 months, five-year local control was 84.4% (95% CI 79.1–88.5%); stage-specific control ranged from 88.8% in stage II and 85.0% in stage III to 57.5% in stage IV.
- Achieving HR-CTV D90 ≥85 Gy EQD2 was independently associated with substantially better local control, with adjusted HR 0.28 (95% CI 0.13–0.57; P<.01). Squamous histology was also favorable, HR 0.41.
- Five-year overall survival was 62.9% (95% CI 56.3–68.8%) after median survival follow-up of 71.1 months. Receiving at least four chemotherapy cycles was independently favorable, HR 0.61, whereas overall treatment time >56 days more than doubled mortality risk, HR 2.12 (95% CI 1.37–3.28; P<.01).
- IMRT was associated with poorer local control in multivariable analysis, but it was disproportionately used for more advanced disease: 69.8% of IMRT patients had stage III disease versus 42.4% with conventional RT. The authors therefore explicitly caution against interpreting this as harm from IMRT; the retrospective study also did not provide a comprehensive toxicity comparison with MRI-guided IGABT.
CLINICAL TAKEAWAY
Where routine MRI-guided brachytherapy is unavailable, a structured CT-based adaptive program can still achieve durable cervical cancer control, even in a population with substantial stage III–IV disease. The study reinforces two familiar but actionable priorities: achieve HR-CTV D90 ≥85 Gy EQD2 when feasible and avoid extending overall treatment beyond 56 days, while recognizing that MRI remains the preferred imaging standard.