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Updated: Mar 21, 2026
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Image-guided adaptive brachytherapy in cervical cancer: Patterns of relapse by brachytherapy planning parameters
Cyrus Chargari1, Renaud Mazeron2, Alexandre Escande3
1Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France; Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; Department of Surgery, Gustave Roussy, Villejuif, France.
Purpose:
Cervical cancer patients with a bulky high-risk clinical target volume (HR-CTV) get the largest benefit of dose escalation in terms of local control. However, the expected survival benefit could be lessened by a higher metastatic risk. We examined the patterns of relapse according to major prognostic factors: the HR-CTV volume and to the D90 HR-CTV.
Methods And Materials:
The clinical records of patients treated with pulsed-dose-rate image-guided adaptive brachytherapy after concurrent pelvic chemoradiation were reviewed. All patients had an optimal workup before treatment comprising a 18-fluorodeoxyglucose positron emission tomography/computed tomography and a para-aortic lymph node dissection. Patients with initial extrapelvic disease were excluded.
Results:
A total of 109 patients fulfilled inclusion criteria. Median followup was 39 months. An HR-CTV volume ≥40 cm(3) was associated with a poorer local failure-free survival. There was a strong inverse correlation between the HR-CTV volume and the D90 of the HR-CTV (correlation coefficient r = -0.696; p < 0.001) with increasing HR-CTV volume being associated with a decreasing D90 HR-CTV. A D90 HR-CTV <85 Gy and an HR-CTV volume ≥40 cm(3) were significant univariate factors for experiencing nonlocal failure (p = 0.002 and 0.035, respectively), even after exclusion of local relapses.
Conclusion:
A lower ability to reach the target D90 HR-CTV planning and an HR-CTV volume ≥ 40 cm(3) correlated with a high propensity of relapsing at distance, these factors being interrelated. Next step of treatment personalization should design strategies integrating this risk, which is now the main cause of failure.
