16. Cervix cancer - The GEC-ESTRO Handbook of Brachytherapy

Cervix cancer

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 01/09/2023

Figure 21. Disease-free survival (A) and local control (B) by FIGO2009 stage in EMBRACE-I study. (Reprinted from The Lancet, 22, Pötter R, Tanderup K, Schmid MP, et al., MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study, 538-547, 2021, with permission from Elsevier).

92%, IVA 91% (Figure 21b). The local and pelvic control rates in Stage IIIB and IVA disease are unprecedented and demonstrate the benefit of MRI-based IGABT in locally advanced disease. Over the decades, various risk factors have been identified to influence patient survival and local tumour control. These can broadly be classified as tumour-related factors (FIGO stage, tumour size, tumour hypoxia/necrosis, tumour histology, uterine corpus involvement, lymph node involvement), patient-related factors (age, performance status/co-morbidity, haemoglobin, lymphocyte/

radiotherapy + MRI-based IGABT involving 1416 patients treated in 24 centres worldwide between 2008 and 2015. The actuarial 5-year disease-free survival rates according to the FIGO 2009 classification were 76% for Stage IB1, 65% for Stage IB2, 73% for Stage IIB, 59% for Stage IIIB, and 47% for Stage IVA disease (Figure 21a). The 5-year disease-free survival for the entire cohort was 68% which is a 10% improvement compared to the Vale series. The 5-year pelvic control rate was 87% across all stages - IB1 95%, IB2 84%, IIB 88%, IIIB 86%, IVA 81%. The 5-year local control rate was 92% across all stages - IB1 98%, IB2 92%, IIB 91%, IIIB